HomeMy WebLinkAboutMortgage_Specht^•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
�_ ; FOR DEDUCTION FROM ASSESSED VALUATION
� State Farm 43709 (R71 / 6-09)
S � PresaibeE by DepartmeN o( Lnral Gwemrtrent Fuance
�STRUCTIONS: ,�,w�t�d
io 6e filed in person a by mail with the Counry Auditor or Counry RecoNer o/ the aounty where the property is locafed. � IV I'I �2
Filirg Dares: 1) Real Pioperty: Must file during the year /or which the deduction is sought. �� County Auditnr
2) Mo6de / ManuFactuled Hanes rrot assessed as Real Property: Must file dunng the hveNe (12J months
6efore March 37 of each year Ne deduction is sought C- � M � nry Reoorder
�
See 2verse side (or addiLOnal instruclions and qualificafions.
AppGrem (ywneror contraa 6uyer- see rgsfirlio�s rn 2verse side) � � �
�
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�fa�N 1, qmml yex
If ro. what is his ! her eracl share of inte25l?
=�a =i8-.��a-oa.3
Mortqage / Cantraa inde6tetlnes5 unpaiO az W Rk
Mard� 7. arrent yrar tla'
rernN's ditterent Nan Nat of appficant. uWitate bebw:
A�dress o( nqrtgagee or mntraG SWer (numbe� and sbee; cily, sta:e. ard
Name ot assignee w other owner or hdder ot mortgage
.�02ss of assgnee (number aM sfreet, wy. slefe, and ZIP code)
property In any oNer
Deduc�on appiwed in Ihe amount of:
20 � 20 � 20 _
Sigfanue
I I We cer[ify uMer Ne penalty
owner I conVact buyer of ihe ��
��
If Owned vrith
VYhatTaun
COUNTYAUDROR
20
Counry
that bove and fwegoing infomialion is We
�ned eM on date applicatlon is filed.
dry, state, and ZIP m
l 1P/X /AO
� or by IC 61.142-0]
: state. antl ZIP mde)
Recortl ewmber Page wmber
-0�.8 0 58��
�] iMebtedrm_ss impaiE as of Is Ihe app�x�ant ttre sole
n legal or eQuilable owneR
� ❑ Yes ❑ No
er tl�an spouse, iMicate wiih whom
Is Mce P�oPeRY in Guestim: MnuaDY ASSeSUV
❑ Real PmPeM ❑ Armualy Psse55ed
MobBe Home QC 61.7-�
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Date (monN, Gay,