HomeMy WebLinkAboutMortgage_Thurston"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fortn 93709 (R71 / 6-W)
S � Presaibed Oy Oepartment of Local Govemment Finance
INSTRUCT10N5:
To be filed in person w by mail with fhe CounryAUditor or Counry Recorder ot the counry where the property is located.
Fi%mg Dates: 7) Real Pmperty: Must hle dunrg the }rear /or which the deduction is sought.
2J Mobile / Manufactured Homes rrot assessed as Real PropeRy Must fi7e dunng the M1vefve (72J monNs
6e(o!e March 37 0! each year the deduction is sougAf.
See rever�gei(fe 7or addifional inshuctiqp� and qualifications.
� l d" -
AseseE ra4ie af mal pfoprJty az W Mortpage / Contr�
fMart3i 7. arrem ym March t. airter ,I
II no, what is ha I hu exatl share OI inteiest9
H name m 2md'¢ 6Rerent Nan Na1 d aPP�+l trtlkam 6ebw
Year
—��^ Remrtl number Page num6er
V
�s unpaid as ot Mortgaga / ConSaU'vbebtedness unpaiE as of Is Ihe app�cant Ihe sde
a aate of aoP�� kgal or epui�ade mmel�
N ❑ Yes ❑ No
It awned vriN someone other ihan spouse. irid'xate with whom
Is Ihe property in Question: MnuaDy Assesse0
_ ❑ Rea� Roaem ❑ %�M �
Moble Home (IC 61.
<._�'
'�"'_
Addtess of �mtga�ee w contraG se0er (num6u and
Name ot assignce w othe! wmer w holder ot mortg: L Ca 15'C' C l�iO. , �OC �/�j�J9
� _'^"'•1•.. ....
�aaa�or��cec��,�,eb�c�m:��e. Card 3��$
NO. ......
.....
Ooes appli�ant ovm property in any other (��'`(� ��
munry in Ind"vna7 � YE5 ❑ No � "�•{�/y,� � ••••
W
COUNit........___
of.
Has this tledWion Deen 2VUesteO m p�opefty
far w�rent Y�n r-i .. r� .
zo � zo _ � zo � zo _ � zo _ � zo _ � zo
r�aMe of CounhAWitw I Counry I oate (monln. aaY.Y�h
I/ We certify under Ne penalry of perjury that Ihe above and (oregoing intortnalion is We end cortect arW ihat ihe applicant is a resident of Intliana and
owner I conVacl6uyer of the aforemer�ioned property on date applicalion is filed.
Irew�g(oy.�r� hN name) '1 Date (month, daY. Yaa�
i 111n.! 1 X,�. ��,.. �.,. l �-�t/ �t:C1
ootle)
fer�n auttwrized Ey duy eseliuted Power of Attomey m by IC 67.1-12-0.7 - ' I�� (rt�W. �Y. Y��' _
Address o( aW�or'¢ed Oerson (n�mbe�aiM stree4 uty. stafi. and LP cotle) - ' '