HomeMy WebLinkAboutMortgage_Coomer (10)" s°*� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES T ip Year
FOR DEDUCTION FROM ASSESSED VALUATION
s�a F«m e3�os �e i z-0»
S w�• � presrnDed by Department W Local Go�emment Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mad wifh the CourrtyAuditor o/ fhe courrty wheie fhe pmpe�ty is located. `�17� ��
Fding Dates: 7) Real Roperty: Dunng the 12 months belae June 77 W the year the deduction is [o be el/ecnvev "`
2) Mobde Homes assessed'mde✓ IC 61.1-7: Belween January 15 end March 2 o/the year��y ��e �
See reverse side (or addtional insWCtions a� qualifications. �
see re,
4
uirr-.�
'T�'"-� .. �' '-"'
of inle2st?
reme on recwtl is differnnl Nan Nat of applicanl, indiole
Nartre of mortgagee oyjaNaG seller
-�oa - oo ��. a �5 -o a �
tyage / Contraa indebtedness unpaid az of March 1,
� ��j lLl o0
If onned with sortreme W
(number and 5ree4 dty, sYafe. arW LP code)
Nartre at assigr�ee or alher owner a ndcer ot mongage
Atldress of assignee (number aIM s6eel. dty. sfate. aiM ZIP oode)
ooes app�n ow�, v�ox� �� �,y ane� u yes. w�,a+�,iy?
cauray in Indtana?
n � . �Yes ❑ No. � � �
7
Deduclbn aoomved in Ne amounl of:
r� / -p n
nudAnr
w�ai ra
COUNTYAUDROR
2(1 _
�s u,e ap�rent tt,e sde �ega� « eqiritade ow+ren
❑Yes ❑No
spouse. indiwte wilh whom.
Is 1he popeM1y in quastim:
❑ Real ProoeM ❑ Mobile Home (IC 61.
DC1\1'G' \�:.0..
...........
c:,�-a �o. ..:.`?��........... ��
�s�,c�co. o° . o No
20 20 20 _
o� ��m.
I/ We certify under the penalry of perjury tliat ttie above and foregoing infwmation is true and correct and tliat tlie appiicants was I were a resident of
Indiana and owner of the atwementioned property on March 1, 20
0
by duly
ot auUwr¢ed pusan
and s6eeL oty, slafe. and LP mae)
a
sfree( cAy, state, aMLPaoOe)
:ST �/.
Da�e (rtnnlh, day, yea�
y� ��
mmN. daY. Y��