HomeMy WebLinkAboutMortgage_Burns.� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
_. FOR DEDUCTION FROM ASSESSED VALUATION
Stala Fam 43709 (R10 /i1-08j
`,.,. , Pmsaibed by DBp3itrnenl of Lo� GovammBM Finat�
INSTRUC710NS:
To 6e filed in peism w 6y med witl� the CouMyAudifor d fhe county wfrere tl�e property is focated.
Fi7irg Dates: 1) Real Properfy: Must file during fhe yeer for which the deduction is saughf.
2) Mo6de /Manufectured Homes not assessed as Real PropeRy: Must fde dunrry tlie hveNe (12J m j tl� ,be(Qre�Ma�cfe�?9 0! eadi year
thedeductanissought. UIV l J Luti�
see reverse side /or addda�l inswd;a�.c ard aua�'Ticarions.
Ma� 7. a�rterit Y� I Mach 1. wrt fl
M ro. what is his / her e�atl shara d iirtereSYt
M reme on record is QAfarem uan that of acvGonl, iMimte belrnr.
a
S•°�'^I
01-�3 . 3 s/- o z�
Nare d assig(ree w ofhar owner a Inlder N nqtiBa7a
Pddress d assigfree (iwwrMOr an0 strcN. tifY• s6fi. an0 LP ooAC)
Ooes a0d��t own papany m ary dhar 7yes. Mat mwyp
muny in indare9 .
❑ Yes ❑ No _ _
rc
blednass unpaid az d is the appfi�E Rre sde
. legal or eqtidabie onr�eR
❑ Yes ❑ No
someo�re anar u�an soause. iriEicate wiH� whrn�
� Ufe a�aaM � auestim: a,nuaMnssessee
-� ❑ Real Proparty Q Mnually ASSesseO
Moti@ Hane (IC 61.1-7
IDITOR
Dedudion app h
Dra�vcr NO.. �`�.� . .
�za o �
= c���a.o. ... aq��....
I / We certl(
owner / mn_ __
�+v�veM
� i za _
�.uQQ� I 4��-aj-oy
_.......a,�.ai is W e antl correU antl tha[ the apptican[ is a resi0ent of Intliana aM
� uie aroremenlioned property o� date application is filed.
�V � Oata (mmN. tlaY. Y�)
F�A rasiEent adEress of a�cant (mvnGaraM sboe7. riQ: sbte. an0 LP co0e)
S-� .� �; nc �.+0 1 n �l l� 7d
aulhorrzetl q tluy ecaaitad Power of iney a by IC 6.1-12-0 ] � Date (�mYh,
PdEr�s d auilurized parson (nvn6or an0 stmef. tity, sbto. anC LP cotlej