HomeMy WebLinkAboutMortgage_Scherzer (2)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7 s ar
__ : FOR DEDUCTION FROM ASSESSED VALUATION
� suce F«m aa�o9 (ai� i s-oe)
� ! P�esrn'betl by Department al Local Govemrtrent Frarice
�� File Mark
lSTRUCTIONS:
To be filed in person w 6y mail witl� the CountyAUdito� or Counry Recorder o/ the counry where the property is bcated. F ���
57irg Dates: 7) Real P/operly: Must file dunng fhe year for which the deduclion is sought. C�. —� �
2) Mo6Ae /Manufactured Homes rrot assessed as Real Property Must file during Me twelve (12J months �
6efore March 31 of each year the deduclion is sought. ❑ C W^�Y
G� ITOR
See revers�e (oradditional instructions an�qual'dications.
n
MP���.t orc�traCbuyn�see reversevde). . .
� ON (� �
ed rdue of rral propaty as of Abr�pag e/ ContraU
1. nermt year lAamh 1. arte`M1 yeE
I( no. whai is h6I her eYacl share Of intelest?
It name m reard'a Srtfemnt tlian that of appOmnt, uMUate bnJOV`
Name 0f rtqrtgagee « mnVatl seller
Atldress of rtartgagee a mntract seDer (number aM strae4 �1Y. stete,
Name ol assignee w athe� avmer or hdder of mortgage /
��
Me2ss o( assignee (number ared sheet �Ry, s7ale, and LP )
Does appiirant own property in any oUer
counrymind'aria? ❑ Yes
amount
20 _ � 20
If y¢s. what munq/?
20
20
WhatTe�drg DiStriH?
20
Reco�d number � Page
az�
Y� u r,o
Wd7ehY in Ouestim: MnuaM Assessed
�I ProPeKY ❑ ����Y �
7- '�- /° i: ��6
s ITis EeOUCtian Deen re4uested m property
a^�"�+ n .,__ r-i
20 � 20
Sigranrte d Counb Aueitw Gaunry Date (monm, aaY. Y�n
I/ We certify u�er Ne penalry of perjury thal the above aM foregoing infortnalion is true and mrtec[ arW that the applipnt is a resident of Indiaria ard
oxmer I contract buyer M the afore entioned property on date application is filed.
SlgnaWre (awneh �) � , � Data (monfh. daY. Y��
� Full mi n� o a t umber and slrect, dty, state, antl LP cade)
:� P a ' eE e te0 Power o eY or by IC 67.1-t2-0.7 Date (rtronN. day, yea�
of authoraed per.,on (number aM street, fi(y, sbte, aM LP code)