HomeMy WebLinkAboutMortgage_Beck (2)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__,_ FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fortn d3709 (R71 / 609)
S�.�. Presaibed M Dev��N o/ Loml GovemmeN Fumnce '
FI
wsrnucnonrs:
b 6e fiied in person w by mail with fhe CounryAuditor or Counry Recoider o/ the county where the property is bcated. J U F� �� �(�':(�
FiNng Dates: 7) Real Property: Mus! file durirg fhe year for whicA the deduction is sought. �� 1'CbUnry Auditnr
2) Mobde / Manufectured Homes not assrssed as Real Properfy: Must file dunrg Me twelve (72) months ❑
6e(ore March 37 0/ each year the deduclion is saght. Counry Recorder
See reverse side far addifional insUUCtions and qualifications. �I �
Appfua (owneraoontreebuyer-eeenwirtbnsmreversasida) � COUNTY AUDITOR
T' istrict Key rwm6er al 'ption Recoid numbrl Paga numbrt
�- - �-300-00% 6 G-oa o a�Y
A¢rsuE rWUe d real �apMy as ot Mpr{p�g e/ Contraa intlebtedness unpaid as W Mortgaqe / Confrar2 iMebtedness unpxM as M Is the epplkant Ihe sde
Mard� 1, ar�art year Mert�h 1, a ntY/�_ date of apPlifation kgal w cquflade owneR
�ro D O ❑ Yes ❑ No
It m, what Is his / tcer eraU shara o/ intrJesi7 1/ awne0 wiN sortieone other ihan spouse,'udkate Mith wMm
riaR18 m fBmrtl
or mntraa seUer (
3/
e a oontran srdes (nvnD�
Name W assi9�ea wWw1 awna or haldu of tmtgage
Aderess o/ assignee (number erd sbeet
Does epplimnt own D�O�Y in a�ry oU�er
munry u� ibana?
❑ Yes
DeEucoon app�oued in tlw amount at
�_ �_
Sigfanne NCounbAiWncr
�I I We certify u r Ne penalty of
owner I contract uyer ot the afor
` / Sig� (owner's���
X
I�'7.'e'
cYy, state, ard LP code)
perty in QuesUm: MnuaDyASSessetl
�PeKY ❑MnualyA�e�ed
. / `)PT/do /�T��t(
Tadn9 Distrifl7 Has Niv d� Gaen reGU�ted m
couNTV nuorror
� i Zo
Caunry
the above and (oregoing information is trve
property on date appliration is filed.
shceG �: sbte, and LP oode)
�N
es¢cuted WwvM of AttornaY a bY IC 61.1-12-0.7
ol autlror'ved person (num0er arM sbeet �: sfate.
a�l � .... -
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a.� �f �i, , .......
C�1.� �O. ..........
� �5iy13 a�
_.,,, ��e applinnt is a resident of Indiara aM
Date (naRh. dsy, Yue�
�a1e (nnrN�. dal%Y��
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