HomeMy WebLinkAboutMortgage_Decker (4)"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_, FOR DEDUCTION FROM ASSESSED VALUATION
� � Slata Fwm 43709 (R11 / 6-09)
� wr Presaibed Gy �eP��M o! Lotal Gwamment FinEnte
ile
INSTRUCT70NS:
To be filed in person w b mail with fhe CountyAud'ROr or Coun Recordet of the caun whera Ihe F� ��
r N ry v�aem a rocared. 'I
F7fig Dates: 7) Real Properry: Must file dunrg fhe yaar for which fhe deduUion is sought S P�pL ttrit�i qudimr
2) Mo6de / Manufactured Fbmes not assessed az Real Property. Mus! file during Me Iwelve (12J months
be(ae Ma�ch 37 of each year the dedudan is saght. ❑ �"n' Re��
i /J �
See rever5e side !or addtipnal instructiDns and qualificafi0n5. �' j� ""' ��{
A1B�rh 1, c�l�etrt yrar
tt ro, what Ls his I her erari shera of IntMe52?
i ��=�v� wuurY P.UDITOR
�"�°=�a-07-/ a� oo (. aa 3-t� a�" U P�° c�� a 1
:/ Contrarl iMnbteEness unpaitl as of Morigage f CmYart'vide0tednrss unpaid as d Is Me eppOranl fha sda
amn[ yeer date of � a epuilatle anrll
❑ Yes ❑ No
if awned Mith wmro other tl�an spouse.'udirste with whom
tl �wrre m remtl s diRerent Man ihat of appOCant. "uMicate Eelmr.
Name at rtnrtgagea or mnraa seAu
sbm,
Pdtlress —...—__
Dra���er NO.��/p........
o� a�,
�� ��
— Card NO. ....�i��: .........
om� j5��J�.�
20 � 20 _ � [U
I/ We cer[ify unde� penatty of
owner I contracf b r af Ne afon
�unue (owrer';jc�H rame)
��J����
�.SevEent address W appfrcani (num0e
nddress o( auG��rzed persan (number and stree4 u�Y.
AUDROR
20
Is Ihe P�GenY in Guestim: MnuaAy AssessM
❑ Real ProPeKY ❑ %��!�Y �
r�, a� �
�- � p-
s� �, P�
Yes ❑ No
�
I Counry'� (`1,`�" "� I Date (narvh. �� � � / �
/�
Ne above and (oregoing infortralion is We and correc[ and that Me applinnt is a residenl of Indiana aM
properry on date appiinbon is fJed.
� s Date (mor�th, daY. Y�e�
�.� Y�6'7U�olri
a cY ic si. �-� z-0.�
�r. r�n