HomeMy WebLinkAboutMortgage_Ross"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C T i Year
�__, FOR DEDUCTION FROM ASSESSED VALUATION
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,' ,�,� Prrsoibed by �ePartmeM o! Lotal Govemnrenl F�umx
Fil Mark
�vsrnucnoNS: D E
To be filed in person of 6y mail wifh the CounryAUditor or Counry Recorder o! the county whe2 the property is located. ����
Filing Dates: 7) Real Properry: Mus! file dunng the year /or which the deduclion is soughL C.' . n��-�\'y""``7 Auditor
2J Mobde / Manufactuied Homes lrot assessed as Real Pmperty Must h7e dunng the hvelve (12) months ry
before MarcA 37 of each year the deduction is sought. L Recorder
See reverse sida 7or additional inshuctions and qualifications. G I BSON
nppficap�(ownerormnvaabuyer-seeres7ncConsmreve side)
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If nartie dt
Key nmCer I legal desaiP� � RemN numbel Page number
a-Ja-o�-/�/-ool. 9�i�_o a-8 J I 3�Y9
prapa:y a of Mortgage / Cantraa inde6ted�s unGaiC as af Morigage 1 ContrarS'viAebtetln�s unG� as d Is Ihe ePP�t tlre sde
Martl� 7, airtent ynar Cate of appGfatian legal or epuitable owne(?
� �{ � n(� /7 ❑ Yes ❑ No
Nartre of mortgagee w coniract seller
rtWitlte beb�v:
or conbact seller (number arM svee4 dN. sbte, aM ZIP code)
asvgnee w other ovmer or tmWer of rtnrtg
qf assignee (number arM , ary. slate,
limnl ovm propeeiy in any Wher
Indatu?
❑ Yes
owned xiM someone aher ihan spouse.
I I( yes. what munry? I W�al Ta�a
No
COUNTYAUDROF
Detluaion approved in the artnum of:
20 20 _ 20 20
Sig�aMe U Co�a
e _-r.
I / We certi(y
owner I mn4
oy
the penalry 5f perjury
yer of Ne afwementic
Counry
ihe pmperty in puesEm: MnuaAy Pssesud
�Reat aiovertv ❑ au,nua�y Assessea
/ 1 U.S.S� '�-����%Z�. � �' 1 r,o
lI -3 �J�¢ �i -
20 [V _ I cv
Date (rtoNh. tlaY.Ypa�
a6ove aM foregoing infortnation is true and correcl ard that Ne appli�ant is a resident of Indiaria and
�erty on date applica0on is filed.
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; ��e. � �
P4tlre55 of auNOraed person (number a� SVee( dy. state, and ZIP oode)
� % I IUC�
Date (mmtli. daY. Y��)
Date (rtpnM. tlay. Ysa�
ry�