HomeMy WebLinkAboutMortgage_Sloan^��+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__, = FOR DEDUCTION FROM ASSESSED VALUATION
• . ' staca Form a97os (R„ � 6-OS)
�' j Presaibed by DeV��rLL of Local GovemmeN Finance
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To be fiied in person w by mail with (he CountyAUditof or Counry Recorder ot tAe oounry whe2 Me property is locafed. U 1. 4�� Lu�9
Fil'mg Dates: 1) Real Pmperty Mus[ file dunng the year for which the deduclion is soughL � Counry Auditor
2) Mo6ile /Manufactured Homes not assesced as Real Property Must file dunng [he fwelve (12) months
before March 37 of each yee� the deduction is soughG "' a�� ry Recorder
See reversa side 7a addi�ional instructbns and qualifications. �
''� MP�nt (oN'He� or aonvad buyu - see restrj�bons m ra�erse side) � '
Tan �ttriG Key number/ legal tlesaiption Reco number Page numEU /
/1,c�-c�rn- - �_o -�03-000. a-18-oat� (�q pas
AsessM rahie d real qopMy as W Mo age / Contraa inde6tedness unpaid az of Mortgage I Contract indebledness unpaid as d Is Vie appikant ihe sole
Ma1ch 1, axreirt year Ma� 1, arteM yPar date of appGntim kgal a equitade owneR
❑ Yes ❑ No
I( no, what a his / her exs(Y slure ol inte�rst? If awned wiN someone oNar than spouse, iMicate with whom
If nartre rn�v.untl n SiIIUent Nan Nat of appOCant, mCinte hebvr. Is Me p�operry in QuesGOn: MnueOy Assessed
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AGdress d�agee w contred se0er
Name o1 assignee w oNer ovmer or hdtler af mart�
naa�s o� �,ee (�umee. em �c mr: �m,
linnt awn praperty in e�ry ONer
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❑ Yes ❑ No
DeEuction apprwed'u� ihe amount
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�r yes. what cwnryt
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Signature d �C�ounN �Au�d'rtyor�� n �) I Couny I oate (month. daY Yee/)
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I/ We certi(y under penalty of perjury at Ihe ahove and (oregoing infortnalion is We and cortec[ ard Nat the applicant is a resident of IrWiana arM
owner I contract buyer of Ne aforementioned property on date application is filed. �
( � (Owneh MI��� Date (rtwnth. deY. Y��
F 1 rrsident atldfess of appGCant (wmDer antl shee4 d1Y, sta aM 2!P ootle)
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Person auNO�vetl Ey duly exewted Power of Atlnney or by IC 61.1-12-0.7 ��e (�^N, �Y• Y��
ACdress of aulhoraed persOn (num0er aM 5bee4 cily. sYdle, and LP Cotle) .
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