HomeMy WebLinkAboutMortgage_Phillips (3)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS s p Year
__ , FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 93709 (R71 / 6-09)
�,�,� � Presmbed by DeP��M of Local GovemmeM Firence
APR 1 @���a
wsrRUCnoNS:
b be filed in person or 6y mad with the County Auditor or Counry Recorder o/ the counry where the poperty is bdted�__ F� �� �
Filing Dates: 1J Real Pmperty. Must hle durirg the yearlor which the deducLOn is mughG ��f County Auditor
2) Mo6de /Manulactuled Homes rat assessed as Real Pioperly: Must Ae during the tweHe (12) mori s
6efore March 3f ot each year the deducfion is sought. OI889N CO NT .. U�9'��I Re�ef
See 2verse side 7or addrlional instructions and qualilxations. -
Asseaed rahc d real prapaty as of
MarN 7, anetY year
what Ls his ! her ema share of interest?
name on'ewr0 is drtterent Nan
legal
t�ri7
:/ Contraci'uNebtednass unpaid as d Mangape / ConSaa iMebteAneu unpaid as d LS ihe epp6canl the sde
curtem year Eate of aDP��? � v equftade wmeY?
��)�kl(l�� nY� nNo
(numbe� and sLeet ci(y, stafe, aM ZIP wde)
w mhr! owner rn hdEer of rtqrtgage
PdEfass ot assignee (numbr! antl sheet �Y, s+ete, antl
OOCS E
county
any
If wmed MiN someona oUUr than spouse.
Is the poperty in Question: MnueDy Asussed
�Real Fvperty ❑ Mnually Assessed
Mobile Hmie fIC 6
Has iha deductim Deen re9ueste� m property
tor artent yeaY! ❑ Yes ❑
COUNTYAUDROR
DeducUOn eDWO'�'v� Ihe amouN at
2p _ 20 _ 2q _ 20 _ 20 _ 20 _ 20
SignaWre W Camb Autlttw Caunry oate (rtorvh. daY. Y��
I/ we cerrofy ufWer the penatty ot perjury that the above aM foregoing intwmation is We and correU arW that the appli�ant is a residem of Indiana and
rnmer I contrad buyer of the aforemenboned property on date application is filed.
� Sq�awre(oxna/shmreme) Date(rtvidi.dav.YeaA
'W resident aEtlrnss d appfrani (numDer and shee4 �; �te. antl Z!P ootle)
Person authw'ved Gy CWy ezewted PoWer oTAftomey or M IC 61.1-12-0.7 �(�+N. �Y. Y��
AdEress of auUror'¢ed Ge� (number a�N sbeeG ury. s+ate. antl LP mde) .