HomeMy WebLinkAboutMortgage_Hale (4)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coun
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fortn 037W (R71 / 6-09)
,�.�. Presaibed q' DePart^�eM of Locai GovemmeN Fumnce �
INSTRUCTIONS:
k be filed in person or by mad with the CountyAUditor or Counry Recorder o/ the counry wheie fhe pioperty is I ted.
Fitirg Dates: 1) Real Property: Must fite dunrg Ne }rea� for which the deducfion is sought.
2J Mobile / Manufactured Homes not assessed as Real Property: Must file dunrrg the fweNe (72) months
befwe March 37 0/ eadr year the deduction is sought.
See reverse side Por addifional inshuctions and qualifications.
MP�m(ownerorart�Ctby�(�'seerestrictif►smrerersesi0e) � 1 fl
mrn t. arrem year I mamn � cy�
Y
rw. what is his / her exacc slure of intrlrst?
name m reco�d'a 6lfemnt Nan thal of aDp�nf, iMinte Cebw
Name ot moR9a9ee or mntract seller
Address of rtartgagee or contran sr�
Ooes a�qiont ovm pmperty in any �
munry m Intl'aria? ❑ Yes
omu�on ap�o� h ma amou�c a
�_ �_
Sigrauae d (:mmb Audifur
I I We certi(y under ihe penam
owner I mntrad buyer of the x
• J
aid az
�
� �� � r
� I� I
�ryAUditor
�ry Remrder
tgage / Cono-aG IndebteEness unpaid as d I Is Ne app�ant Me sde
r of appGfation kgal ar epultade wmeR
❑ Yes ❑ No
someone aUrer Ihan spouse, kMicate wtth wfnm
Is ihe propeny in Question: Mnually Assessed
� Real PfoPeKY ❑ ��a�Y �
I�� �� ��
�y,DObaa'/
�010 - ��(
7
�7
- �- Z�-
Date (r�pr�. day Y��
ortect arM that the applirant is a resident o( IrWiana and
Person auNO�ved Oy dWy ezecuted Porer W Pnomey or by IC 61.1-12-0.7 Date (nmM. E�:
Address d aWmr'¢e� pr�sm (numbel arnd maet «IY, sbfe, aM ZlPCaee) .