HomeMy WebLinkAboutMortgage_Sands^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Trnmship vear
_ FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 93709 (R71 / 6-09) � � � �
�' Prew�betl M DePaR��erd af Loml Govemmerd Fnarce
�w File Mark
NSTRUCTIONS:
To 6e filed in ty ty F� �� ���
person or by mail with the CountyAuditor or Coun Recorder of the coun 2t �o�¢{�j is located.
Filirrg Dates: i) Real Pioperty: Musf file during Ne year Por which Ihe deducfion is soug� 1�`k L�+" �County Auditor
2) Mobile / Manufactured Homes nof assessed as Real Property Must file dun�rg the fweHe (12) months
before March 31 ot each year the deduction is sought. C. J, � ❑ Counry Recorder
See reverse side for adAQronal instructions and qualfications. �
Key
If ro. what a ttis I trer esa`Y stiare ot m[rlesf!
1f rame m mmd a EilFerent Nan Nat W appfi�ant, i�Wifate behvf
Name of mwigagee «mntrar� seller
Addres of mor[gagee or contrar] seder (numDer and s R dty. sbte.
Name of assignee u dher owner or hdder of mortgage
Address ot azseyree (rum6eraM streek �Y. �e. antl ZIP cotle)
Ooes a�imnt rnm popaty in any other
county in Intlana?_ — _.-- _
� 5ra co f� � 5Pr �ns
, i i-3(�a �-
- a- ooa � i�-c� .8._..�...w. � . �_... aa
s unpaiE az W Mortgage / ConVaa inaebieErress impaid as N Is Ne a00�t the wk
` dala ot appGtation legal a eQuitade owneR
� ❑ Yes ❑ No
If wrt�ed wiCi someane oMer ihan spouse. Indicate wiih whom
�s me wcaem �� auPStion: nnnuaM wsussea
❑ Real RoPeRY ❑ !�^��h! � . . _,
munry? � Nrtwt iapng
C_�.J I � I �.�� 9�
I/ We certiry u�er the pen Iry of perjury t Ne above aM
owner I mntracY buyer of the afwementioned property on da
ireWre (owne/s fi�Orurrrel
ent adOr¢s ot appfraTd(number aM stree4 mY. sbre, and [/N oa
��06 q�_(��� � 1�r
Persm a Wpf'ved Ay dtiy eseated Power W AttaneY a�' IC 61.7-12-0.7
Address of autha¢ed person (numberand sneeG riry. slate. and Z!P oode)
nuortoa
Auclbn Deen repuestetl m propvly
�� ❑ Yes ❑ No
za � �_ �_
��� - ��,�.�y �
� oa
ig information is true and cortect anE Mat the applipnt is a resident of Irdiara aM
ation is filed. .
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