HomeMy WebLinkAboutMortgage_CreceliusSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun sh' r
_ , FOR DEDUCTION FROM ASSESSED VALUATION .i �
State Fwm a3709IR11 / s-09)
,„„ Pr�oibetl by DepartmeM ol locW Govemmenl Fuiarxe
wsrRUCnoNS: ��� 201t
To 6e filed in Form 0ed wiM:
person w by mail with the CountyAuditor or Counry Recorder of the counry where the property is located. C
Fitirg Dates: i) Real Pmperty: Must file dunrg the }rear /or which the deduction is soughL a��
2) Mo6ile /Manuladured Homes rat assessed as Real Property: Must file during the hveNe (12J rtwnths [� �
befae March 31 ofeach yearthe deduGion is saqht. GIB ON GOUN�TY UDIT er
See 2verse side (or addilionef inshuctions aiM qualifications.
Appfxant(owreroroontraUb✓Ye�-�re�s vemesir/e) •
(�LJ
T District Key nimbn+/ Iegal d�aiption Remrd numha Page numbrl
.�� a�-�i_�� -/o3-ooa. 3�a-oa8 a.
rc m. what Is Ivs! her e:ar1 shara of iHeiest?
If narne m remtl is dAterenl than lhat of app0ont, uditate bebw:
rdame m rtaRaa9� � m,raa se0e. �/ �
Address of nqrtgagce w mntracl se�er (number e stree4 �1: ffite,
Name of atsignee v Wher wmer rn haNU M mort9a9e
Address ol asv �e (n`V�stree4 �'. s�efe. and ZIP totle) �
Dces applinN wm WopeM1y in anY otlier It yes. what m
counry in IMana? ❑ Y2S ❑ No
Omumon approve0
��1
� - � - r • - -
I/ We certify under Ne penalry of
ovmer I contrad buyer of Ne afor
,LOO �
Pasoo aw,orrsee cy
shee4
�debtetlness unpaid es of Mongage / ConbaG'vde6tedness �mPaid as d Is Ne e0�� the sde
date o1 appfication kgal or aquilade or*�e(t
D D � ❑ Yes ❑ No
rc a�mad with someorre aher Wn spouse. mEkata uiN wMm
Is the property in QuesUOn: MnueDy A1sesse0
Q Real Pfopefty � Mnually Assessed
C.Q�'-�'1.15' M'►� (�
Wl�at Tadrg
ao��-a�s
1UDROR
b
No
2b 2O_ N_ 20_ 20_
Counry Dem (rtrmth. daY• Y'�A
the and foregoing infortnalion is we and cortea and that Ne appfinnt is a resident of Indiare aM
pm on date appiication is filed.
person (number and SLeet, dt}; sfate, aM ZIP oode)
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oa�e (mo�rn, ear. rea�