HomeMy WebLinkAboutMortgage_Horath^ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co . ns ip
._ FOR DEDUCTION FROM ASSESSED VALUATION g 2QO9
State Farm 43709 (R70 /11-08) /��/
� yu � Prasai6edbY�PartnientdLOC�Govemrter�Firence �H�
INSTRUCTIONS: .�yh Fl��
To 6e filetl in person w 6y med witlr Ure CountyAud�ilar o/ fhe county where the property is focated. ���
A�ing oates: 1) aea� rroperty: Must hle dunny the yoar lo. wnicn the deduction is souync r,1[; OUNT Y AUDITOR
2) Mo6�7e /Manuladured Homes rrot assessed as Real Ploperty: Must fde tlunrg the lweNe (12J6�Sferire Merch 31 0! earh year
the deduction is sought
See reverse side fa adddional insfrudions and quafifrcafions
AppGarn lownri or M�iw- see mstririims an seel I
AfaN� i, amertl yea I Mamli 1, wrqql
�!t
H ro. wtat's ha / �er azaC shae d ir6�rest7
tl rame m remrd is d�areM Ihan that of aOG�l'oiEimle Cebv`
Pmrass m rtnr�agee a mntratl seoa (�umDert �
Narre d assignee w Wher wmer or holder d morl
Addrass d a�ignee (iwrtOrf and sbenL N-Y• sfale
Daes aPpG�nl own popeNy in a�ry other
DeEudion apPrwed � Iha amouM af:
r1 I'"-��
I/Wet
owner I
-a s-
l00 � -Oa.L � `� 3 I �6
� Co�Eracl inOeWeOneu un{aid as d Is lhe app&aN B� mle
�fimtion . legal or e9udable ownefl
❑ Yes ❑ No
tl amed with sameone a�her t7un sOwse. iMicate wdh wtvn
Is tha prapetty in Guesfion: AmuaDY ASSe55ed
❑ Real Proparty ❑ Mnually ASSesseA
Mohile Hartie (IC 61.1-7'
(���fw-2 �JZ- o b - `1331
aoos
Dra�ver NO ...................
Card NO. ..3�'Q?�.°.........
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COUNTY AUDITOR
lltis
20 � N1 � 20
b9en repuesied on P�M
�d� �/�� I Caunh I Date (� �
�
the penalty of ihat the abave artl foregdng mfortnatian is true arW correcl and Ihat Ue appficant is a
yer af the aforem poperty on date applicatio� is filed.
F s'Mant ad�(e�s dapplicant
U . G
Parson aw,oRee nr a�y e�ea,�
Addrau d authar¢ed 7arson (ni
�ala�.
s
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Date (marth. EaY• K'a/)
20
and