HomeMy WebLinkAboutMortgage_Rodgers (4)".>^^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
s�e r-o�, aa�as �rta i zon
S ur � Prasmbad bY Depahmenl d Loral Go�emmeM Finance
INSTRUCTIONS:
To be filed rn person or by mad with the CouMyAuditw d the courrty whe/e fhe properfy is bcated.
Fding Dates: 1 J Real Property: During the f 2 months before June 11 d tfre year the deduction is to be efiective.
2f Mobile Hames esseued /mder IC E7.1-7: Behveen January 15 end March 2 0/ the yea� the deducfion is t� �effect�e.2009
See reverse side lor edd'rtional ins6ucGons aM qualifications.
. ApplicaM (�moonVaC 6uyer-s�e9�ans m ravum side) O�%6� N/!°'1
� �r C2y�_%lu�� �� �c�.� _�oD- OGY� ..�/-D a-o
'�d value of real P�4�Y as d March 1. a�l Y�r Mariga9e / ConLad indeWetlness unVaid as of Martli 1.
that ot aPW��L indmle 6elox:
Nartre of nqr�gagee ar mnUad sdler �
AdEress of mortgagee a caniraC seller (number and str
Name af assgriee a dher oaner a hdder of mMgage
Addrass of ass9nee (mmbei and sUeeC rnY, sfale. erd
epplitanl own property in erry oihm
y in Indana7
� Ye"s ❑ No
ction appmved in Ihe amounl oL
p �% 20
20
. I If awnetl wilh somea�e
(� �
fa. ard LP cade)
countyt What Tacing D'alrict7
couNrr auorroR
20 20 _
��b
I ol6o y I �So.�
Is 1he appfifant Ihe sde legal u equitade wvrieR
❑Yes ❑ No
spouse, indicale with whom.
I5 �he proparty in QuesUan:
❑ Real PnmerN O Modle Home OC G7.
_ ' 7 _---
q .....
Dra���cr \0......�}��•
8
Card NO. :.....�•••••""'
� I I'�y07. o0
20
20
I I We certify under the penally a( perjury that ihe above and foregoing infomiatio� is W e and mrtecl and fhat the appGCanfs was I were a resident of
Indiana and owner of ihe aforert�entioned property on March 1, 20
� .,ylyNae faunaYS Rdl namsl /A i ,
Dale (mmN. tlaY• Y��
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Person
addrass
du y e<eated Pwrer d Adaney or by IC 6
peson (nwnberand sLeet, aty, sfafe, aM
�
� /�Date (monfh, day, yea�