HomeMy WebLinkAboutMortgage_Littlepage"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS onn o Year
_, : FOR DEDUCTION FROM ASSESSED VALUATION -
� . � StateFwm43709(R77/609) / 1 �[UlU
, wu 1 P2saibetl by OepanmeN of L.oml GavemmeH Fi'ance � Q
INSTRUCTIONS:
V`.J File Mark
To 6e lled in person or 6y mail wiN the CountyAuditor or Counry Recorder o/ the county where the propeRy is located.'�J� %/ F�
Filing Dates: 1) Real Property: Musf file dunng the year fw which Ihe deduclion is soughG ✓ � Q�����d��p�
2) Mo6de /Manulactured Homes not assessed as Real P�operty Musf file during the IweHe (12J month . pJ
befole MarCh 37 oleach year the deduction is soughL G18� �n' Counry Recorder
See ieversa side !or add8ronal instnrctions end qual�cafions.
MP�ntlowne�prconJrart6uyzr-seeresfiraonsga�vzrj�slda) w
AsesseC vaLe�f�A'Roperty as of
MarCh 1, airt�
If no. what is his I Mr exa7 share of i�,
If name on iem�d's tlillerent Nan Na
Name of mwigagea or conttacl uller
�
aearess ot nnrb�agce or cw,o-aa sen
_ a �-�i6.o/�-o�
Mortpage / Contract iMehtedness unpaid az of Mongage /(
Marr}� 1, artent yesr-� „ _� tlate of appG
Name ot assignee w other rnmer or hdder o1 rtortgage
Aetlress of assi9nce (numOer arcl stree4 d+Y. yete,
wm property in any
ctiy. stam. aM ZIP code)
inGebtedrress �mpaid as of Is Ne appfrcant Ne sde
legalQ �epuitaWe ame(7
lCd Yes ❑ No
is the property in questim: MnuaM.4ssessea
[�� ProPenY ❑ ArmualyAsu55ed
n.�,wiP Fw�w nr. a
What Tadrg Distnc[? I Has Nis deduCion Oeen re9uested m P�Y
for wrtem yPaY? �--� , n
ducCOnaPYwedm eam mo. Lt a�i-er i\�0...�Q�
v....
2p_ 20_ CaY(� 1���. , ... �— p
� �...y�Q.......
��aa,re a cau,a nwi�r ��,{� oate Onaw, mr. ree�)
I/ We certify under the penalry of perjury Nac u�� .._ _ �"�--CpQt` p U and Uat the aDW�mnt is a resident of Indiana aM
owner I contracl buver of the aforementioned prooerry on date apy�.,..__. O�
FWI msidem a0dress d appGCant (numbei antl sflee( tiry, state, an0 Z(P catle)
>C //2 f 3�! ST. /��/.,a,�. i v
Person aullror2eE Ey Auty esecuted Power o( Attomey or Cy IC Gi. 12-0.7
AEtlress of authw'¢eC person (numDar aM sbaet, ciry. sfate. arM LP code)
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Date (nmth, daY. Y��
/- �Jo. 9n/
Date (monN. tlaY. Yae�