HomeMy WebLinkAboutMortgage_George (3)°� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
s�a Fm,�, a3�os �Re i z-0�
�° � Presrnbed M OePaNnerq of Local Govemmerrt Finance
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wsrnucnoNS:
To be filed in person or by mad with the Cou/rtyAudifor W Ure courtty wheia the propeAy is bceted.
Fdti�g Dates: 1 J Real Propel(y.� Dunng the 12 months belore June 17 0/ the year the deduction is fo be eRective.
2) Mo6ile Harres assessed rmder fC 6-1.1-7: Behveen January 15 end Ma�ch 2 of fhe yeer the deduction is to be e�r�J3. 1 4 2009
See reverse side /or additional insbactions arM qualifications. '
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Key number /
I—//�'If/riill�� f/:i��s J//.�L��il�L�/!'
irWipte below:
Name of mortgagee or corNaq sellsr� /��
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AEdrzcs of moM1gagce a mntreC sdler (number an0 streeL dty, s!
Name of assignee a Wier awnar w hdder of maAgage
Address M assi9�e (�wmber and sGeet dty, sfafe. aM LP mde)
applicaM o.m P��rtY in erry olher I If yes. whffi
y in InC'iare7
❑Yes ❑ No
m equitahle oxneR
❑Yes ❑ No
wqh someone olher Uw� spouse. iMicate wiN wlwm.
�Ist/t�e property in quasUm:
qQ Real Pmperty ❑ MoGle Hortte
Has Ihis dedudion been requested on poperty
fa arrenl yeaR
---- . ..._ ❑Yes ❑No
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p� �_ �_ _ . . - - � � 13y .... �0 20_
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inature ot CamryAuQMr .�t �' f7/ �'�•�• oale (man(h, daY Y��)
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I/ We certify under ihe penalry of perjury thal the above and foregoing intomiation is true and mrrect and that the appGnnts was / were a resident of
Indiana and owner of the aforementioned property on March 1, 20
Date mon(h.OaY Y��
�naWre(awnrXsfidlriame) � _ (
�sidenl address oT appli�aN (n
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Person auUtrnaed bY Euy acealetl
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or
s6eet aty, sfata, and LP code)
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