HomeMy WebLinkAboutMortgage_Roney^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T ship Year
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FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 93709 (R71 / 6-09)
` � Prescr�betl M DeP��rd o1 Local GovemrtreN Fuiarce
File Mark
�lNSTRUCiIONS: A,(� �]
To 6e filed in person w by mail with the CountyAUdito� or Counry Recorder of the county where the pioperty is lot3Y�. J 0 ���
Filirg Dates: 1) Real PmpeRy: Must file dunng fhe yrear /or which the deduction is sought. (, ^ unry Audimr
2) Mobi/e / Manufactured Homes not assessed as Real Pmperty Must h7e dunng the hvelve (12J manths
before March 37 of each year the deduction is sought Counry Recorder
See reverse side for additionel instruct6ons and qualifications. G�ggpN COUN
AnNfE�m f��wner ormnlraC buver See restri'��bns m reyerse sdel
Assessetl rdue d real P�D�Y ��
Ma�rh 1, qa2n[ `Rar
If ro. what a his / her euct share of interest?
If rwne m remftl a dMuent Ihan that of appt
P/
Name ot mort9agee «mntrad seUer
/ legal EeSfYipUm
rc�.�a�i.�a
'�
Unpaitl as of
ot mortgagee a mntracl seAer (number aM sLee( ciry. stefe. eM ZIP cade)
rvame o� assgnee w omer avmer or naaer m mortgage
P4dress of assignee (num6ei eM sbeeR �y. sbte,
Does eoWKant own v�a�Y
oouny in IMana? r
a7P�'�
20
i any oNer If yes, what county.� lM�
Yes ❑ No
� COUNTY AUI
�un[ of. �
20 _ 20 _ 20
RemrE rwm6rl Page numCer
\ � �
eMedness unpeid az ot is ihe applkant the soie
kgal w equilade owne(1
❑ Yes ❑ No
n spouse. IMicate riN �vlwm
Is Ihe property m Vuestion: Mnua�y Psessetl
ealRopeAy ❑ nrmuanyassessed
Moble F�brtie (IC 61.1-7
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Dra�ti�er i1'0..�����
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Carcl !\r0. ...,'�,!',S / CJ •'
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2i1 � 20
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I/ We certify urder the penalry of perjury that Ne above and (oregoing infomiation is We and corteU and Mat ihe applipnt is a resident of Indiana and
owner I contracl huyer of Ne aforemeq4qned property on date appliration is filetl.
�Y
adJshee[, tlty, s3re. antl Z1P code)
JAtlom wbyIC61.1-12-0.7
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Date (monN. daY Ye�