HomeMy WebLinkAboutMortgage_Miller (11)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
__ FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 93709 (R11 / 6-09) .
S,.,, � Presaibed bY �Partment ol Lowl Govemment Firence
i a
�VSTRUCTIONS: � .
To be filed in person or by mail wifh the CountyAuditw or Counry Rernrder o/ fhe counry where tAe property is located.
Filing Dates: 1J Real Property Mus! file durirqJ the year for which the deduction is mughL � Counry Audimr
2) Mo6Be / Manufacfurcd Hanes rrot assessed as Real Property Must h7e dunng the twelve (12) months J A rt� 7� -i � n� �ecordu
6efae March 31 of each year the ded�rction is sought. '+��� .CO(im�
See 2verse side l�c�ddrtional instnictbns arM qualifications. C.� �vb, �_�
npprram(o�mer ,quyer-seerest�c�"'s°77vers�sidelu� \ �iit �� ��
� � �,�
Mardf 1, tll�P1G yPaf
If no, what a h's I her e�U share o( intercst?
t -v-i- 7va-
Morigage I ContraG'udebtedness i
Mart�h 1, wrtent yegr
If name on reco�d is CiRerent than ihat ot aPP�nt.
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Pildress W mortyagee ar mntract seJler (nurti0er and st%et �+N, stare, antl ZIP
Name of azsignee or oMr.r ovmer w holder ol rtmgage
Address ot assignee (numDer and shee4 tlt1: state,
'�"-�^.'RI
Deduc6w� apyaved o� the amoun[ of.
20 _ � 20
Signature W CounNAWimr
If yes. what wunty.�
20
date of appfcalion
ot ( Is Ne appGrant Na sde
kgal w equitable oMneR
❑ Yes ❑ No
If owmed wiM somew�e other than spouse. inditate with whom
What Tad�y DisviU?
GOUNTY AUDROR
20 20 _
Counry
MnuaDyPSSessed
� �Of `� _— _
�t 5� ,
(^^�r
Y�
� ' I.�� �O• �
20
20
❑ No
1/ We certify under Ne penalry of perjury that the above antl foregoing infortnalion is We and cortect and tha[ Ne appli�ant is a resident of Irdiana aM
owner I conVad buyer of the afo2mentioned property on date applicatlon is filed.
�nayre (ownry5)5dl namy) .. Date (rtmfh, daY. Year)
� � �
�
tlry, st�t� ard
w by IC G1.1-12-0J
Adtlmss of authoraed p�vsm (number ard saee4 �y. state, antl LP code)
Date (monfh. daY. Y��