HomeMy WebLinkAboutMortgage_Jenkins (4)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ = FOR DEDUCTION FROM ASSESSED VALUATION
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INSTRUCTIONS:
b be filed in person w by mail with fhe CounryAUditor or Counry RecoNer ol the county where the property is bcated.
Filing Dates: 1i Real Properly: Must file dunng the year for which the deducfion is soughf.
2) Mo6de / ManufactureC Homes not assessed as Real PropeRy Mus! file dunng the twelve (12) montAs
before Ma�ch 37 0/ eacA year the deduction is sought.
See 2verse side for addrtbnal instnictlons and qualifications. „
i�dng Oi 'ct // Keyru e /IegalOesai
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AtsesseE �ah�e of real property es of MoRgag e/ Cc
MaM 1. aneN Y� Mard� 1. n�m
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H n2me pt IBODId'a dAfeRnt N3n that o! app6�anC h�difate Geb
Name m m�xtgagea mnaxt seeer
PCdr� d rt�cgagee m m�traU se�er (mmbv and stree
Name ol assimiee w dhc owner rn hdEer of _.
Counry Auditor
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�tetlness unpaid as N Mortgage I Con indebte0ness �mpaiE as ot tv Me apqh�nt tlre mie
date d appGCatm legal a epuitade ox+uR
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�r wmee wim son,wrre omm tw, sw�. �wwrate wim vA,on,
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Pdd�ass of astignce (numDer eM sveet ary, s7ale, eM ZIP code)
Oces applimm own property in eny oNer If yes. what
county m Ind'ana? r-� __ ri ..
NTat Taring
Quesson: nnmielly Ass�see
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COUNTY AUDROR
Deduction apywed in the amount ot
20 _ 20 _ 20 20 _ 20 20 _ 2(1 _
SignaLae U Counb Auekw Caunry Date (month. daY. Y�A
1/ We certiy undef Ue penatty of pe�ury Nat the above antl foregaing informatlon is true and wnect aM that Ne applicant is a resident ot Indiana and
owner / mntracl buyer oi the afaemeMioned property on date applicatlon is filed.
. �99�+� (owne/s 7uDname) . oate (nnrW. daY. Yge�)
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FW revEe�t d eppfimnl (iwmDer enE f, 'y, state, and LP e) . /
� O 2 M I N R /L. ti/ C e'T'� il( �
P�son auth«�d by dulY exewted Pa�uer o/ AvaneY M IC 61.t-12-0.7 Date (monM. tlaY. Y��i
ME2ss o( auCror'ved person (num6ereM sbeef, dry, state, aid LP oode) .