HomeMy WebLinkAboutMortgage_Huff"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 437091R11 / 609)
,' w�. � PiesaiCeC by DePM�M of Lotal Govemment Fi�nce
INSTRUCTIONS:
Fo�4 p�
To be filed in person w by mail with fhe CounryAUditor or Counry RecoNer o/ the oounry where the propeRy is located. I p N�j � Z� � 2
Fd'mg Dates: 7) Real Property Must file durirg the year for which !he deduclion is sought �L J� County Aud'Rnr
2) Mobde / ManufaUured Homes not assessed as Real Pmperty Must file dunng the tweHe (12) monfhs �.�
6efwe March 31 of each yrear the deduction is sought �� ��d
See 2verse side for additional insWCfions and qualifrcations.
:ed vaNe d rral pmperty as W
1. namnt year
what R his I Mr eraG share ol interesi?
If name m recorG a&I(e�mt Nan Nat of aPWirant. uWifate bebw:
Name of mortgagee or mntrxt seller �
J
Add25s of rtnrt9agee or contract s�er (numbrf and sfrce4 �y. slate,
Name of azsignee w other owner or holder d mortgage
(number arM stree4 �; sfafe, and ZIP cotle) �
wperty in any oNer If yes. whal counn
Deducfion appoveC in ihe amount oh.
2o i Zo
Sigfuture o( Counry Auditn
2�
unpaid as of Mortgage I ContraU "vWebtedrress unpaid as d Is the ap�t Me sole
date of appfi�lion legal w equitade w.+�eY.�
❑ Yes ❑ No
oNer Ihan sywse. indicate with wMm
h Ihe P�G�Y in Vunstion: MnuaDy Assessed
❑ Real afoaero ❑ ����N �
llra�ve►••NO. �� � �.......... «��������«�,�,�
nr ❑ Yes ❑ No
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Cai•cl \O . .....................
�1g5,000. �
_ _
20
t/ We certify uMer the penalry of perjury Nat Ne above and (oregoing infortnation is We and corteG and Nat Ne appluant is a resident of IMiana aM
amer I mntrad buyer of the a(orementioned property on date application is filed.
7�iawre�wne/s (u7w 9a^'a) �\ r/./A n Date (monN. daY. Wa�
identatltl(€ss �pfnnt(n mberarlC t,tlry,state, LPmtle)
S�-o G��-s-�-� �'�-��
aW iw¢ed Gy dWy exewted Power UAVOrtiey or by IC F1.1-12-0.7
person (num0er antl streeL ary. state.
�
Date (monN, tlaY• Y��