HomeMy WebLinkAboutMortgage_Keehn (3)°�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Qou TownshiF
FOR DEDUCTION FROM ASSESSED VALUATION �
s�a r-� as�os (Ra i z-0�
�' � Presmbed bY �n�t d Laral Gavemment Fimrwe
..� �' I LF'�`�
INSTRUCTIONS:
To be filed in person w by mad with U�e CourrtyAuditor W the couirty where the property is located.
Fding Dates: 7) Real PropeAy: Dunng the 72 months be/ore June 71 W the }rear the deduction is to be elfective.
2) Mobi7e Hames assessed aMer !C G7.1-7: Betxeen January 15 and Mamh 2 0/ the year the deductim i�(y,pe SflekUt{{�09
See leverse snie far add6onal mstrvdions a� qualifications. Y(( I) y LU
"°"�'"ix��`��i°�,-s�,�����gaa� l .. .. „ _ . `�r�,a�
r ois�p Keynumber/Iegaldesaiption GIB A� `"
G - ia -6 - o - �o�. �3 i -oa� �
a,�d �ad,e ot rea� po�xy as d n�a�n i. ane� r� � I Contrad intlebledness unPaid as of MarU 1. Is Ihe app6ont Ihe sde lagal w equiiable wrne(1
�rt�� /DD (� ❑Yes ❑No
I�what is his / ha e.xa�t shara W interesl7 If owred with sort�eme oli�er Uw� spouse. indipte wilh whom.
If iume m recad is ditte�aM Ihan Ihet of appli�anl, intliole below: Is Uie property in question:
❑ Real PropeAy ❑ Modle Home QC frt.
mortgageeorconlraUSdbr �/�
of moAgagee m m�vaa seller (iuenber streeG
Name of a5signee or Wier owner w holtlar o1 mortgage
Address d assignee (rcmbe` aM s6aet. dty. state. and LP mde)
Does applicaN o.m P�WBRY in arry olhm It yes, what
�� � ��d���
❑Yes ❑No
Deduction aPPmved "m ihe amaud o(:
., • "���
a� LP code)
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d� J
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zo _ � 20
o� �„�u,. �,; r�n
0
I I We certify under the penalty W perjury that the above and foregoing informauon is true and cortect and that Uie appGnnis was I were a resident of
Indiana and owner oi tlie aforementioned property on Mar�h i, 20 _
i�owne/s fiA n�me) _.. __ Dale (manfh. daY. Y��)
nn_. \ /
sfafe, an0 LP oode)
Pmmn auUwr¢ed by duty erzewled Pwver of Altaney a by IC 61.1-12-.07 � Oala (mmlh. day, yee�
Address d au�hor¢ed pcvson (number and s6eef, cdy, sfafa, arrd LP mde)