HomeMy WebLinkAboutMortgage_Manges°'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C To i Year
_ , FOR DEDUCTION FROM ASSESSED VALUATION
i.. .. � s�ace Form aa�os (Ri � i s-o9)
�' � Ptesrfibed by �epartment af Lopl Govemment Fuance
,w APR 2�� p�j'j
INSTRUCTIONS:
To be filed in rson w b mail with fhe Coun Auditor or Coun Recorder of Ihe coun whe2 the ro F� �� ��
Pe Y �Y b' �Y P PertY is located. C. �
Filirg Dates: 7) Real Property: Must file durirg the year for which Ihe deduction is sought. unTy Auditor
2) Mo6�7e / Manulactured Homes rrot assessed as Real Property.� Must file dunng the hvelve (f2) onths ry
beforeMa�ch3lofeachyearthedeductionissought. �IBSONC UN q DITORc��de�
See 2verse side (o� adtldional instrucGOns and qualfications.
AppGpnt (owneror cantrarl6uyer- sre rewirlfons on reverse sitle) . � _ . �
�r / legal desoiption
��_�A
��ar���
1, aamnt year
what is his / her exarl share of intereSY?
If name on rc�nN a E'MU¢nt Nan ihat of apptifani, indinte bela�r.
:�
�x
Name of assignee a oNer owner or hdder of mwtgage
A4Cress ot assignee (number arM stree4 �1; slate, and ZIP code)
Does aPWicanl onn pmce i ther If yes. what
counryinlMiana? /� �_.
20 I 20 I 20
\ Reco�dJr um
, 1 9�b
unpaitl as ot Mwtgage / Contrart indebtedr�s unpaiE as o(
datc of apptifation
If owned with someone dher ihan spouse, iMinte with i
Wha� Ta�dn9 �istnct?
IUNTY AUDROR
20 20 _
Cauny
Page number
1'[=i���L•]
Is ihe pmperty in Question: MnuaP� Assessed
�Real PmPeAY Q ArmUaRyAssessed
Mobile Fbme fIC 6
n
Has Nis deductwn Eeen mquested on
for current year? . r-� _ _
20 � 20
day,yea�
I I We cerlify under the penalry oi perjury that the above arW foregoing intortnalion is true and correct arM that the applinnt is a resident of indiana arW
owner I contracl buyer qfy�e aforemerrtioned property on date appiicatlon is filed.
�1:
autho�.W Ey duy execute0 Power of Attorney rn try IC 61.1-12-0.7
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Dare (monM,day,yea�