HomeMy WebLinkAboutMortgage_Farris"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun wnship Year
:�_, : FOR DEDUCTION FROM ASSESSED VALUATION
� Slate Fortn 43709 (Rt t/ fi09)
S f P�esoibe� by Department of Loral Govemr�nt Fitglxe
File Mark
INSTRUCTIONS:
To 6e filed in person or 6y mail with the CounryAUditor or County Recorder o/ the county wherc the pioperty is located. F� 4 Z00�
FiN�g Dates: 1) Real Pioperty Must file durrng the year (or which the deduction is sought. �Counry Auditor
2J Mo6�7e / Manu(actured Homes not assessed as Real Property Must fife during fhe fweNe (12) months
before March 37 0/ each year Ne deduction is sought �nt� er
See reversa side la addifional instrtictions arM quali�cations_ G CO
M (VA+��oroqrWaC4 Y�r-seeresn+'A��fIXireverseside) ' �
's1 vahie cd real D�PMY as of
1, qm1¢ year
what I5 his ! her e�md shaie of interesi?
oc��VUU�� Q�— ii%(1% J�`i �CJ IX O rtea��u ��u"'w� ruye ��u�J �
(/(J(l lJ
�/ Contrarl'udebtedn�s unpaid az of Mwtgage / Con:ract c�tlebted�s �mpaid a d Is Vie appOrsnt the mle
airtent Y� date of avP�� �J� � w M���de amel?
p x �. � ❑ Yes ❑ No
If name on remE a diRermt Nan Nat of aPp�an; inEibte bebw.
Nama ot rtqrtga9ee a mntrarl
ctly. sb�, aM ZIP oode)
Name a� assignee w other owner or hdder of mortgage
Addrea of assynee (number eM atree4 �: sla+e. entl ZIP cotle)
Oces epplipnt ovm property in any oNer If yes, wh:
munry in Ind"¢na?
❑ Yes ❑ No
DetlucUan appraveE in the amaum ot
20 _ 20 20 _
Sign3ture of Caunty Auditor
�f awned with sameme other Ihan spouse, IM&a[e with whom
COUNTYAUDROR
20 � 20
Counry
,1-5-,�(e propeRyinQurstion:Mnuallyh55e55ed
�Rea1 Property Q ArmuaVy Assessed
7� Mobile Flort�e (IC 6
Drawer NO....°.�.p0� •,•
Card NO. ....�� •••••••
r� ' �] 1�
�Dale (rtmntl�, daY. Yee�)
1 I We cerOfy under the penalty of peryury Nai Ne ahove aM foregoing infortnation is We and cortect and Nat Ne applirant is a resident of Indiaria arW
owner / mntraG buyer ot ihe aforementioned Droperty on da[e application is filed.
Sigrewre (pareh hEl y3rtre) i Date Q*+rnfi, daY, i��
ard 21P cotle)
.� " f Q/ iJ C.l: S�i'
Ey CWy eaewted Paxer o(Attorney w by IC 61.1-12-0.7
Mdress o( auCmr¢ed person (number arM sLee; �ity, state,
nM, daY Y�� - -