HomeMy WebLinkAboutMortgage_Lloyd (4)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vea
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fwm C37W (R77 / 609)
� PresviEeO CY DeP�N o(Lnd GovemnmN Wiarre -
Fi a
INSTRUCTIONS:
To be filed in person w by mail wdh the CounryAUditw or Counry Recorder o/ the county where the property is located. �
Filirrg Dates: 1) Real Property Must file durirg the yearlor which the deduction is soughG I n Auditor
2J Mobr7e /Manuladured Hwnes rpt assessed as Real Property Must file dunng Ne lweNe (72J months� U L 1 Q� ry
6efore March 37 of each year the deduction is soughf. Counry Recordu
See 2verse side /oradditional instructlons and quali�catrons. �y� ��,
_/—,� /�v—+ c�t co — �( �U — —
A�¢sed vehie d real poperty as d Mwtqa ge / Contract indehtedn¢s un{
MaM� 1. dmrtl ypar Mamh 1. a�rtent yeer
�
�i M. W�13� 6 �16 � iMf CFdQ S�1dfB O� Yl}PlC5l7
It name on recoN is tlitfefan ihan Nat of applkant, Indibte below.
Nartre of rtrortgagee or mniratl seller
amress d rtert�agee or mno-aa seo
M
51atB.
i a of Mortgage / CmSaa'vWe6tedness unpaid as a( Is ihe appfaant Me sole
Eace of a pGCation � legal w equitade owner+
�� ��$, ❑ Yes ❑ No
tt awned with someone otheJ than sPO��. ind2ate wtth whom
I5 Ihe property in puesUan: MnuaOy Assessed
❑ Real Pioperty ❑ Annually Assessed
Does aPW�nt ovm property in any oNer I II yes, what count�? . I What Tap�g D6GiG7 .
m,�y �� i�aa��
❑ Yes ❑ No
f�
r�i
Dedumon apprwed in the amount oF. '
20 20 _ 20 _ 20 _ �� ' "� � • 20 _
�����,C� ��"' 11
Sg�aDi2WCO�nbAUdimr p q� "..•••
a....
I/ We certity under Uie penatty of perjury Ihat Ihe above and foregoing infortnatia C:1� a\ O �!�� •� _.,�uent of Indiana arul
wmer / mntrad buyer of the aforementioned property on date appiintion is filed. �{�� I
Sip�aW�e (owireYs h�rome) Date (nmfi. daY. Y��)
�:/-.... . �. 0 .
� Full res' ent W ap� " t(n n er arM street. ciry, stare, antl ZIP ca
Pason a�� d Power of Attm�ey w Cy IC 6t.142-0J
Attm
ldCress of auUVtred persan (number aM s�aet �: state, a�M LP coUe)
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