HomeMy WebLinkAboutMortgage_Bailey (9)_rynSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ip r y
: FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn C37W (R11 / 6-09)
�` ,.,� � Presuibe0 Cy Departrt�eM of La�l C»vemmeM Finance
INSTRUCTIONS: �
To 6e filed in person w by mail with the CounryAuditw or Counry Recoider o/ Ne counry where tAe property is located. F� �� ��
F�irg Dates: 1) Real Property: Must file dufig the yearlor whicA fhe deduction is mughL �• ��
2) Mo6Ae / Manufactured Hanes not assessed as Real Property Must file dunng Ne hvefve (12) months
before March 31 o/each year the deduction is saght. �°�^ �
See reversa side !or addiUona/ instructions arrd qualrficafions.
Aoo6rant m owitract 6ut�er- see resDi'1b9s MYe�wsP si�l
ed vehre d real papMY as ot
1. aa�ent year
m
Name W rtnrtgagee a mntract seller
Addr� a1 rtartgagee or mntrad
Name W assignee a oNer owner
ADtl�ass
�
�kam oMn poa«tv in ary aner
Indena? • ❑ Yes � ❑
Dra�ver �\'O.. a�� �
— - v —
AIMpa9e / Contracl indrbtedness un{
Mam}� 7. a�rmnt yrar
ri mdica4 Ceio�r.
(�lS..�
�and street u�Y. sta.e. aM LP code)
rtgage � / �
o,� �
ae, andZlPmtle)
If yes. v.hal muntyt
c��-� ���o. ...5235 �2°
� rr7_\ •
�J. /V —o� � � Q �0 Pa9e �✓
d MMgage / Con7aG hW v� as d Is tlm ePP�+� the sole
tlate af appGcatun /%,� � legal or epuilade oxneR
� � . ".0 . ❑ Yes ❑ No
�-a-i�
Wlia� Tawg DistricY?
\UDROR
zo
Is property in Ouestion: Mm�aoy A.sesu0
Real RoPeKY � ���N��
Mobile Hare (IC 6
•337a�e,
Has Ih's de0w]ion been reGUested m pioperty
tor au'ein yeaR r-i .. r-i .
zo_ � zo_
Il�l�y�5. c,�; � � ,��
., .. ..�u�y ��wn u�e w����� �� w�rv�r �w� uro above a� foregoing iMortnalion is We and corte�3 and that the appiinnt is a resident of IrMiana arW
au�er 1 contrad 6uyer of the afixementioned property on date application is filed.
Pason autM�'ved
.�'G3G3
person (numCcr aM stree; ay, stale, arM LP mde)
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oa�e c,rwxn, aa�; r�r�