HomeMy WebLinkAboutMortgage_Reed (5)^'�+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ : FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 0.3709 (R71 / 6-09)
, � Presaibed by Departmertl o1 Local Gorernment Firence
F"1 a
INSTRUCTIONS:
To be filed in person a by mail wifh the CountyAUditw or County Rewrder of fhe counry where lhe property is located. �
Filirg Dates: 1) Real Property: Must file dunng the year /or which the deduction is sought Counry Audilor
2) Mobile / Manuladured Homes rat assesced as Real Property: Must file dunng Me fweNe (12) months
befora March 31 0! each year the deduction is suught. C�EB°��R�e�
See 2verse side for additional instrucUons end qualifications.
AoWn t( r or contrart b�yer - see rey�:na�s m reverse s:�p) 1 ..
{�� �L� �
Asessed vehc d 2al P�P�Y as ot Moriga9e / Ca
i1, aareiV year Marrh 1.
rc m, rmat a nis � ner eaau shara or inte�est?
If rwne on 2cad is EHferent Nan Nat ot appOmnt, i�Milate rn
Name ot mwtga9ee or mntraU seller
Pddress of rtprtga9� ar mntraG se�er (number end sfi ". .__
Name
halde� of mortgage
(�„m0e� ena aaeec ar. slate. em:
difant onn yoperry in any aher
Indiana? ❑ Yes
D�ucEan
20 _ I 20
SignaMe d
aa indebtedness unpaN as d I Mongage / CaruacT'viEebtedness
year Cate o( appGfation
tt owned with wmeone other than spouse.
Dra�ver'NO.. oiQ(Q ........
of Is Ne appfi�nl Me sole
legal w equitaWe bwneR
❑ Yes ❑ No
i �N�om
Is the property in puestion: MnuaDy Asessed
❑ Reai a�oaenv ❑ a�,�,anywss�s�
blobile Hpire (IC 61.
� Card NO. ...�.°.�ca�......... ��,�d���,������,P�m
x a(rent yeaY.+ � Yes ❑
- �(o�T,171. �'—
COUNITnuuiiun - �
20 � 20 _ � 2b
Caunry
20 � 20 —
I/ We certify under the penatty of perjury that the above and toregoing infortnation is We and cortect arM Nat the appiinnt is a resident of Irdiana and
owner I contract Duyer of the aforememioned properry on date application is filed.
3�WrelayqefsM1Armme) / �. � DatelrtwRh.daY.Y��)
ezew4d
riry, slate, antl Z/P code)
AltomeY a M IC 61. b12-07
of aW�a¢ed persm (num0er eM sbeet, cdy. state,
Date (rtronN. EaY. Yea�