HomeMy WebLinkAboutMortgage_Chamberlain (5)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ FOR DEDUCTION FROM A VALUATION
� Stata Fortn 93709 (R71 /6-09) ��� �� ULY ENTER FOR TAXATfO
S Presaibetl by Departmenl ol Lacai Govemm t Fre S� '
ie a
� INSTRUCTIONS: ^ �. �n4 _ ddy 0�
P Y �Y ��PF�VMf � �Y P Fmn t�ea wim:
To be filed in erson or b mail with Ne Coun Auditor or e coun where the mn�vs t.
Fdiny Dates: 1) Real Property: Must file dunn the �`, � J•
g year (or which Ne deduction is soughL C���ddnr
2) Mo6Re / Manufectumd Homes rrot assesseda�F!ea�MUSf file during the hveHe (12) months
before Ma2h 37 of each year the deduction is s�wgh[ (� Gi9soncQ�der
Seereversesrcle7aadtlitiona�ja1WUionsarMqual���rnii��rv nrno Parcela
ApplraM (o�me� or conlydrJ b.- ee�ivic¢'ons m reee� sidy� � � ;� '
.n�cc'vn
m.
narne
Name of mongagee a convact sener
� U'-L�dJ' /lJl'
Mort9a9e / Contraa intlebteC�ss �
Mamh 7, ai ar I�,.�
V Q�
. uiAicace bebw.
Mdress of mMga9ee w cantracl se4er (number and sbee4 �Y, s+a.e, aM LP
Name ot assignee or other awner or
aearess
street �y, s+afi,
lirent wm propeM1y in aity olher I �
InCia�?
❑ Yes ❑ No
umuaon aGWwea c� me
20 _
Sigfawre N CoimN Audiwr
�o•�IS?-O�d6 ����
az U Mortgaqa I Con7aa uMebtedness unPaiE as d Is the
date of app�catm legal i
�N�+mt3��.�, � y���
/�i _/� ( �
Yes LI No
�:'
Is IM P�GenY in Guestion: Mnually Assessed
❑ Real Roperty ❑ Armualy Pssessed
Moble Fbrne (IC 6
Nas Ih's deAUebon been re9uesteA m P�WertY
tor w�rent yeaR ❑ Yes ❑ I
20 _ I 20- I 20 _ I 20 _ I 20 ' 20 _
��
I/ We�¢ rtify under Ne penalry ot perjury Ihat Ne above and foregoing infortnalion is W e and correcl and that Ne applicant is a resident of Indiana aM
ownerlcontract buyer of the afinementirned properry on date application is filed.
i re(W�'�1eYS hNnartre) Date (maafi. daY• yea�
�
��� ,��
or
person (number arM street U}: state, and LP mtle)
Date (monN, tlaY Yea�