HomeMy WebLinkAboutMortgage_Neese� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
, FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Farm 43709 (R71 / 609)
� Presaibetl Oy Department a( La�l GovemmeM Finance
F
INSTRUCTIONS:
A
To be lled in person w by mail with fhe Counry Auditor or Counry Recorder o! the county where the pioperty is Iocate�AY
Fil'mg Dates: 1) Real Pmperty: Musf file durirg the year for which the deduclion is soughf. unry Auditnr
2J Mo6Ae / Manufectured Homes rat assessed as Real Property: Must h7e dunrg the fwefve (72) months
betae March 31 0/ each yaar the deduclion is soughG � Cou^�Y Recorde�
See raverse si0e for a�djfional instructlons arn1 qua(firatjQns.
= ii=ia-�oi-
is:�.uZ,'a
rc�o.�c�sn�sina�aay,areor�rereu� /
tt �urne m remN 6 C'ifferent Wn Ihat of appOpk. "viEica� DeW.r.
rlame o� rtartgagee « cmo-aa seoer
Mdress o/ mvtqagee a contraU s�a (mmDer end sbaet �Y. sb�.
Name d essignee or athei owner or hddg d rtprtpaga
Ooes eppifant c
m,MV in �naara
DetlucOOn appm
2� _
I / We ceNfy
Pe1wn auttwriud Dy
Dra�ver NO.a.��.�........
Card 1\i0. .......!..!.l........
�' i O lo� 3� 9. az�
a. as�-oaa `�'""�'�u P�°°�`9i
Mon9a9e / Contrxt indebtedness unCaiE as o! Is Ne epp&gnt 1he sde
eate oi aOP� � a��e ownM
❑ Yes ❑ No
i with son,eme ahar ttwi s�uu. indkate with whon,
Is the property in QuesUm: MnuaP/ AssesseE
❑ Re� a�o�env � ^�N ass�s�
Wlqt Tarin9 D'strxY? Nas U�is tleCwYim Oeen re9uested m ptoprlty
�a�� � �
�— i p— i Zo—
d'rtw Counry Oate (monfh. daY•Y��1
� A A �.t ,�.r S-� I o
�r Na pe Iry of perjury that e a ve arW foregoing infortnatlon is trve and mrtect arM Nat the applirant is a resident of Indiana arM
�uyer of e afo2me�rtioned rty on date appliration is filed.
neme) Date (month. daY.Y��
-7 �l S- � -i�J
d�xant n Oerantl� (dty,stafe rrdZlPaotle) .
5`` /�u�e. 7G7o
�mr erzea,tea aower autn„ey a cr �c s�.�-�z-0.� oate �mmfn, ear. rean
person (numAer e� sfi.•et �: sfate, an0 Z!P mde) .