HomeMy WebLinkAboutMortgage_Miller (14)""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
.�_ .
; FOR DEDUCTION FROM ASSESSED VALUATION
SFata FOrtn d3709 (R71 / 6-09)
� � Precrnbed by Department of Lorrl Govemment Frence
INSTRUCTIONS:
To 6e filed in F
person w by mail with fhe CountyAUditor or Counry Recorder o/ the county wfiere the property is locateii� � � �
Filiig Dates: i) Real Pmperty: Musf file dunrg the year Por which the deducfion is sought Counry Auditnr
2) Mo6ile / Manulactured Homes rwt assessed as Real Property: Must file dunng the txelve (72) months
6efore March 37 of each year the deduction is sought. '—y„� �❑� County Recorder
Q �( f
See reverse side /oradditio'nal instnations and ouafi�catrons. . (/
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Ma`rf� 1, anrst yPar
If m. what ¢ ha / tcer exact share 0! interest7
�l-/a- la/- DD a- a'7S o a� I�b O
7 indebtetlness unpaid as of Mortgage / Contract indebtedness unpaid as of
,^.er ��� Eate of applicatiOn
��a,��a�,�,�� � S/3
AGtlress of nvtgagrP w`mtract seeer (mmber aM sLee; cify. .. aM LP code)
NamaoTas: - — .--.
nda� or
bra�veri\'O�Uoy_,�S9v —
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munryinl
Card i�'p, — —
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�e�uction aGWo� m �... _.
20 2f1_ 20_ ' 20
What Ta�dtg Datrid?
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P�SSc�
Yes LI No
spwse. inakate wm wnom
Is the p�operty in puestion: MnueAy AssesseC
❑ Real F.oaertv ❑ Mn�aIN Assessed
Has Uis deAur�on Eeen re7uesteE an pmprny
forartentyeaY.� � __ �
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Date
20
I/ We ce� under � pena of perjury�t Ne above and foregoing information is W e and cortect arM Nat the applicant is a resident of Intliana arW
owner I contract buy of the aforeme`rti ed property on date application is filed. _ _
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ull.re40ent atldress o7 appl'rcani (numberand streef, a sfate, and ZIP ootle)
0 30� ,v_ vr/, �ve. ��;n� at�,
Person aWarimd Dy duy executed Power of AtlomeY a M IC G7.1-12-0.7
Atldress of auCrarsed person (number anE saee; rity, sbla, aM LP code)
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