HomeMy WebLinkAboutMortgage_Bailey (10)°^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun s r
FOR DEDUCTION FROM ASSESSED VALUATION
s�ie Form aa�os �Ra r zv»
S,.,. � Resrnbed M Depa�ment W Local Go�emment Finance
File Mark
INSTRUCTIONS: �� ��
To be filed in person or by mad wRh the Cou�rtyAuditor or the courrty where the property is located.
Fdmg Dates: 1J Real Property: Dunng the 12 months before June 11 01 tfie year the deduction is to be et(ective.
2) Mobile Hames assessed uiMer IC 6-1.1-7: Bahveen January 15 and March 2 o)the year the deduc6o�m81��V6�Y AUDITOR
See reverse side (or additiorrel ins6uttions a� qualificatiorts. �
Applicant (µme/pr mnhad 6uyer - see Rffiiclians m rfyverse sidB)
Key num6m / legal desoiplion //
�.Z�er� %(v-/� -/�-/��'f- o0
��,�ya,ornwti,,.wre�ar� ����comaeo,c�
a�rten�year � .
1 IF s`et is his / I�er exaci share
I IF reme on
seller
belav
� ndm¢� ur monqagee ar mn�ae seller (numcer ar'e s4aec oN. srare.
� Name af assgnee or olher owner
nda� or
munry mPir
�perty in e�ry olher
❑ Yes ❑ No
� OeduGion approved in Ne
0
� Sig�ature ot Counry fwdnor
0
Record number Page mlmbr�
ti�a-oa��' 008 Y587
�iness unPaid as or March 1. Is ihe appGCant 1he sde tegal a equita6le wrtmR
ODD ❑re5 ❑ No
If owned wifh sameone other Ihan spouu, indicate wiN whom.
Is Ihe properiy in �estim:
❑ R�I Pmperiy ❑ Mobiie Home QC G1.1-7)
Dra�ver NO...�� �
� .....::.
...
�Z,P�,e� c 7
ard nj0. ...
.... �..........
If yes, whal counl/! VJhsl Te�dng Disl
COUNTYAUDROR
20 20 20
Camry
20 _ � 20 _
I/ We certify under the penally of perjury that the above and fwegoing infomiation is We and corred and tlial the applinnts was / were a residen[ of
Indiana and owner of the aforementioned property on March 1, 20
;�e (owne�s IW na / /� . n ' Date (rmn�, daY• Y��)
� //_
arM LP co�e) 1
of Atiphey w by IC 61.1
M author¢ed pe�son (num6er aM streef, aly, state,
tt�,a �l �l l9 7 D
Dale (month. day, yea�