HomeMy WebLinkAboutMortgage_Boling (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co wns i Year
__ ., FOR DEDUCTION FROM ASSESSED VALUATION
������„i�>
� y,� � Prr3aibeE by OeV��b of Lnd Gwemma�ri Fvunm
File Mark
INSTRUCTIONS:
orm A
To be filed in person w by mail wiN tAe CountyAuditor or Counry Recorder o/ the county where the pioperry is located.
Fiting Dates: 1) Real Property: Must file dunrg the year for which the deduction is wughL �un Audiwr
2) Ab6r7e / Manufectured Homes rrot assessed as Real Properry: Must file during Ne M1reHe (12) months
6efae March 31 0( each year the deduction is mught. ecorder
See �everse side /or add�rtionaf instnxtions alM qualilcafions. GIBS
App�n or buYe/-seems�SOns siie) �
C��
Key number / kyal desaiption -7 Remrtl Pag n�
r / '
Ass�sed rahie d rnal p�oprny as d M1brtgage/ Cantraa 4de6tr�ness unpaid as of age I Caniraa iiMebtedness unpaiC as d Is Ne eppl'mant Ne sde
MarM 1. anmt Y� Mamh 1. arteM ��y date af aVP��^ kgal v equitaWe wme!!
n2m8 at
Nama of rtartgagee or mntract seller ��
ACdress o1 nnrtgageE or mntracl se�u (n ar
Name ol assi�ee or dhei avmer or halder W rtwrtc
AilEress ot assignee (number entl ahxt �Y, s+ete,
Daea e�nt own popeM1y in any other
counry m Intliana? �f Yes ❑ No
20
I / We CErOfy ufu
owner I mntrad
are a�ru oe
uiCirate Eelrnv:
sfam,
��O ❑ Yes ❑ No
n aw�,ea wnn mm�e otlmr mm, sad+�. mc�te wnn wnan
la Ihe P�PertY in GueSUOn: Mnue�Y A.Se55etl
eal ProPenY ❑ �^^^�Y �
Z,P�a� DI'al5'C'C 1�'0...�pl Q
it ye:. �+a� munq? Ca rd i\�Q. ,. ..
...���� '.
���... `� %�7, �f70.C� �
20 _ 20 _ 20 _ 20 _
Caunry
�enalry of perju t Ne above aM foregoing infortnalion is We and correct arM that the
�f Ne aforeme � ed property on date application is fileE.
. � � . . / . 1
�FWI revErn�t]aE�es opf app�fxani (num�0.erLa�si��/ 4 d��N, st�ate�, en/.d. �L�P� oo�tl{�.{� �
��U C7 S. (.�U.P �% 3G. filA/l�1"IV. J I`� u�"�J�'v
,rPP15on aWar'¢Ed by dWy rsearteC Fowtr of AuomeY a �Y IC 61.7-12-0.7�
�I Address of autha've0 persan (number aM street �Y. sbte. en0 LP oode) .
a�v�i
'�a
o� (�nm. dar. ��
lirant is a resident o( Indiana and
Date (month. daY• Yaa+)
Date (monN. Eay: yea�