HomeMy WebLinkAboutMortgage_Pokorney'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
.�_—..
• FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 43709IR71 / 6-W )
��«. j Presaibetl Dy Departrnerd of Lncal Gwemme�v fiiance
File Mark
�vsTRUCnoNS: �
Fam e 'Ih:
To 6e filed in person or by mail wilA the CountyAuditor or Counry Recorder of the county whe�e the property is located.
Fd"mg Da[es: 1) Real Property: Mus! !le during the yaar for which the deduclion is sought �� ���..AUei��
2) Mobde / Manufactured Hanes not assesced as Real Property Must hie dunng the nvelve (72) months iC"--'�
betore Mamh 31 0/ each year the deduclion is sovyht ❑ �+���e�
SeereversesideloradditionalinsUUGionsandqualifications. G� UDITOR
MoM�am (ownerorcontraa bea�e� - sea resvirmnt on 2eerse sitlel /�
rnimber / legal d�aiption
� —17—/h f_
11 iq.
I/ riame on rewrd
Name oi mort�agee or mntract seuer
�''J � "-^/�
_ V
"uWebcedness unpaid as of Mortgage / Cantract inde6tedness unpaitl as d I Is Ni
� date of aPP�� ��
� If awrretl wiN sorneone aher than spouse. i�ifate wiN �W�wn
w cantract seller (number aM sbeet, crty, sbte, aM ZIP code)
ovmer or
svee; pry. siate.
Does appficant ovm ploperty in any other I If yes,
[ounty in Indana?
❑ Yes ❑ NO
COUNNAUDROR _
iRatle amel�
Yes ❑ No
Is ihe VmPertY in Question: MnuaM Pssessed
❑ Reai amaem ❑ nm,�y n�
far
� P�nY
DeducGOn appravcd in Ihe amount of:
{�KI�QI���� ,1�,>,c� �-6-1�.
zo zo z zo zo
Sgnawre N Cwnry Autlitor ��' �'� D� � Date (rtnnth. AaY, Yee�
I I We ceNfy uMer Ne penalry of perjury that th v� Q � r��O U y ��°2� %/ hat ihe applirant is a resident of IMiana arW
owneS! mntracl buyer of the afo2men�oned pr �� `�' /� �( - -
� h �
FWI msident atltlmss d
dty, state, antl Z/P
Pddress of authw'seC person (numDer arM stree( dry, sla(e, antl Z/P code)