HomeMy WebLinkAboutMortgage_Elpers (41)^�+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
___ • FOR DEDUCTION PROM ASSESSED VALUATION
� �• State Fortn 437091R11 / 6-09)
t' ,w ` Presaibed by DeP��M of Lod Gwemrnent Fuiance
File Mark
�TRUCTIONS: MA F � .
To 6e filed in person or by mail with Ihe County Auditor or Counry Recorder of the county wM1ere the property is located.
Fil'mg Dates: 7) Real Pmperty: Must file during Ne year /or which the deduction is sought. C. N�, -�unty Auditnr
• 2J Mobile /Manulactured Homes not assessed as Real Property Must file dunng the fwefve (72) months
before March 37 of eacA year the deduction is snught. ty Recorder
See reverse side (or addilional instruct+ons arM qualifications. G I BSON
nppfrany(mmerar cwivart 6uyer - seArestriraora m reverse sde)
T�" Oistriyt ey �wm6er I iegal description Remrd num0er Page numoel
a �_ �03-00�. 9s8- oa8 0 /3`�`�
��ue a( real p(op¢rty a5 W nga ge / Contracl intlebtetln¢ss unpaid as of Mor�q e I ContraH " ebtedness unpaiE as d Is Ne app(iranl the sale
Ma�d� 7, amrX7� M N� 1. wrtent year date o legal or eWitable ovme(t
a � ❑ Yes ❑ No
If ro, what's h's I hx euct share ot infcrest? ff ovmeC wiN someo�re oth tlan spouse. ind'rcate with wtwm
If nartre m recotd is dMnmit Nan Ihat ot aDW��4 �ditate Oebw. Is ihe Properry in question: Mnualy Pssessee
❑ Real Roperty Q AmuaDy Assessed
Mohde Flartie (IC 61.1-i
Name N rrort8a9ee contran seller /� ^, dJ � � �/ _ _
l/i A T.�n a- T v���7rv ��QP�. 1�
Sty� w . . —_ / —
Pddress ot rtnrtga9ee et cmtrad seAer (n and sLeeC crty, state, ard ZIP oode) �
Name of assignee
di�ni Own propetty in any olher
���� ❑ Yes
pyEUCOOn approved'e� tl�e amouni
20 _ � 20
of Counry Autlitw
ci(y, sfale. erd ZIP tade)
WhatTa�dtgOistri� '
Di•a�ver NO..°.�Ql.°�........
COUNTYAUOROR
20 20 2C
County
I/ We certify under Ue penalry of(�erjury that the a
owner I contract buyer of Ihe aforementioned pro
� Sig� (ownersfiNname)
FWI �esi ent atld of a rant ( mber and ary state
Y s�
Peison aW�omeE DY duy exewted Powe+otAmmey w Cy IC
Pdtlress of authaved person (number a�d sLee4 ciry. slafe.
c�ra , o. .!.�.`l.1............
Da1e (rtvRh. CaY. Y��)
e and toregoing infortnation is we and mrrect arM Nat the applimnt is a resdent of Indiana ard
on date applicatlon is filed. -
Date (mavh. day, Year)
F
I �V �V
Date (monN. tlaY.