HomeMy WebLinkAboutMortgage_Taylor (10)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES � ou Trnd sh Yea�_
_. • FOR DEDUCTION FROM ASSESSED VALUATION �
- � $Idfe Fwm 63709 (R71 / 6-09)
�' ,.�� ` Presvibed by Departrnent of Loml Govemrtrent Frence
�CT 1 � Mark
wsrRUCnoNS:
Fortn Aed wiN:
To be filed in person o� by mail with the CounryAud'ROr or Counry Recorder o( the counry where the property is loca(ed. 6`/ _�
Fiiirg Dates: 1) Real Pioperry: Must file tlunig the year for which the deduction is sought. O�n� �^ �unty Auditor
2) Mobile / Manulactured Homes rrof assessed as Real Pruperty Must f+le dunng the hveNe (72) monfhs � p
beforeMarch3loleachyearthedeductionissought. D�asONCdU TY����EuntyRecorder
See reverse siCe lor additional instructions and qualificatrons.
�Y
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MaRh i. tlrreltl yYdr
Ii rq, what'a his / Fcer e�d 5halB o( interest?
If name m remN is diRerent ihan that of appOrant, mdica[e beb�r.
mortgagee or mntraa
a
i- � .�• JI"Va� u v-
inCe6teEness unpaitl az ot Mortgage / Contraa'uWehtedness unpaid as of
r date af appG�a[ion
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Oy IC 61.1-12-0]
AdtlmsS of a Wia�ueE person (number a� 5tree; city. sfafe,
iitatle amM
Yes ❑ No
Is ihe G�PenY in Ouesbon: MnuaM Assessetl
❑ Real ProPertY ❑ ArmualyAssessed
Mobile FI«rie (IC Cr7.
dion eeen reQ�eseea «i o�r
3n � Yes ❑ N�
_ 2�
e (nrmfh. daY• Y��
�nt is a resident of Indiana afM
te (monfi, day, ysa�
�f ?co? (�
. . Oate (rxnN. daY. Y��