HomeMy WebLinkAboutMortgage_Banet (2)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS un a4ns ip Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
• 51ate Fwm 93709IR71 / 609)
S � Prewibe0 by OepartrneM of Lad Goremrtrent Fvance
Fil
INSTRUCTIONS: -
To be fi7ed in person w by maii with the CountyAUditor or Counry Recortler o/ the county where the pmperty is locat�' �'
Fi/mg Dates: i) Real Property Must file dunng the year7or which the tleCuction is sought.
2) Mobde / Manu7adured Homes not assessed as Real Property: Must file during the hrefve (12Jmmt1�� n Auditnr
before March 37 01 each year the eeduction is snu�ghG li1COUN C UN Al�l���dw
�y
See reverse side for additiunal inshuctions end qualdirations.
AppGmnl( mcvntraab r- mreversevde)
�
Ta ' i' Key / kgal desaiption R¢mrtl numbar Page number
- i- -i -c�a . 6 - a �i �y �
As� va4c U mal 7roDenY as of e/ Cantract irde6tetlness unPaid as of Mangage / Con�raU'vWe6tedness un7aid as of Is Ne aOP�t tlx sole
�' a�p f.brN29 'taU
yrdr Mart3i 1 a� t yeer Ea[8 of appllUtion legal or equitade Owneft
� � ❑ Yes ❑ No
.f no. what � Ns / ha exaG share ot intrlestt If awned wiM someone athel Ihan spouse. trdkata Wih wfnm
tt(wne m recad b NRerent than that of appGCaN, uiOUate Eelovr Is in Ouestian: Mnua9y Ass¢sed
I ProPaKY ❑ M��a�Y 'A�tss�
Moble Home QC 61.7-7
Name ot rtartBx9ee ar con sell� ��
Pdd�ss d rtartgagee w mntraG sWU lmm6er end sVeeC UY. state. aM LP code)
Name a1 asvy�ee m oNu oxner or tmlder af mortgage
Mdfess ot assignee (number antl street, tlry, slafe. end LP cotle)
Does appli�nt own property in any oNer If yes, whal count�? 4Mat Ta�dng D'aUid7 Has Nis Cedupion 6een reQUested on proprJty
counry in IM'rana? ❑ Yes ❑ No tor arrent yeaR
❑ Yes ❑ No
GOUNTYAUDROR
Deduc7on aPP�� In Ihe amoun .
20 _ 20 _ 20 _ 20 20 _ 20 _ 20 _
Sig�adrte of Caunry NtlRw Caunry Date (rtnivh. tlaY, Y��
I/ We certify urWer ihe penatty of perjury that the above and foregoing intortnation is we and cortea arW Nat che applicant is a resident of IfMiana aM
owner I wntract buyer of ihe aforemeMioned property on date application is fited.
Sig`uniMa (owne/s h� � v✓ v"„�" / VY Date (/nonfi, daY. Yaa�
�1- - /
tID ent edtlre55 of appfxant (pumber and sbee4 slate. and ZIP ootle)
O �% ,c�r /��E ��,scE a -� s2 f!7G JQ - � � —
Person authwrzed Gy duy ezeurted Power o(AttcmeY � b1' IC Fi7.1-72�.7 Date (mmN. day, yea�
Atltlress of euthortred perem (number a�M sbee; cfly, sbte, aM ZIP code) .