HomeMy WebLinkAboutMortgage_Sorg^`+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
.. __ s FOR DEDUCTION PROM ASSESSED VALUATION
• Stale Fam 43709 (R71/609)
�' f pr¢svibad b� Departmem af Laral Govemment Frexe
� INSTRUCTIONS:
To 6e filed in person w by mail with the CountyAuditw or Counry Rewrder of the aounty wFiere the poperty is
� 2 F �,�:
Fifing Dates: 1 J Real Property: Mus[ file dumg the yrear for which the deduclion is soughG Counry Auditor
2J Mob�le /Manulactured Homes irot assessed as Real Praperty: Must file during the fwelve (12) menths Counry Recorder
belore March 31 of each year the deducfion is srought. �
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Seereverseside7oradd'Rionalinstructionsandqwlificafions. _ ,,,,,,,,,,, __.____
fa �rg �' tria Key numher / legal ticuript�! � � // Remrd number Page numbnl
(a-�3- �' l�o_ooa.��o _oa�/ � 7
vWUe d real poperty a d Mongage/ Cantract'uWehtetlnrss unpaid as of Mongage / ContrarY indebtetlness unpaid as W Is Ihe eppiksnt Ne sole
7. mrenl ym Ma2h 1, arrent yeer tlate of aPP�� legal ar epuitade mmeY.+
p2 Q 9 � Q� ❑ Yes ❑ No
R ro. whal is his! her eYaU share of inieJesi? tt owned xi;h someone oth� tlun . uWicate wftli whom
If narne m reoDrd is 6tferenl than iha� at aPp6�nl md'uale bnbw. �Is�tM,,{p_r_o,perty in puestion: MnuaDy AssesseE
CY �cra� ProPeM1Y ❑ A!?�ualh' As�ed . . _
Name af mortgagee or mntract seuer f/ �
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Address of nnrt9agee w contracl se0er (n and sm
Name ol assignee w other owner or hdder of rtqrtgage
AdE of assignee (numDer arN sReet �: sbte, an0
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Oces epplirvnt ovm yoperty in any olher'
munryinlMiana? r-i .. r� ..
ar
zo I zo
I I We certify under Ne penalry �t perjury that
ovmer I contraa buyer of the aforemerrtioned
3^aryue(� 1Wname) /J
ciry, state, eM ZIP code)
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What'
couNrraun�
zo
Count
and foregoing infortnation
n date apWicatlon is filed.,
idani adOress of a�firant (number and stm�3tv �te, erd LPOOde) n�� /�
�S�d-�% ���' /cJ-UO S T' ., /_ / i _ //
ys,u.�..� �zz�-
auNOr'¢ed Gy dWy ezearted Powel af Attamey ar by IC 61.1-12-0.7
s ot authwaed person (numberaM sbee4 ciry. stare, an0 LP code) .
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�
�uaion heen re0uestee m proprity
� ❑ ves ❑ No
5o R � m�.l � �
/'yJ rGrf-f�s'L /
Io7- I 77l
Date (monm, aaY. Y��1
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