HomeMy WebLinkAboutMortgage_Harms (2)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
__ FOR DEDUCTION FROM ASSESSED VALUATION
51at9 Fortn 03709 (R71 / 609)
�' y,. � PresaiDed M Department o( Loml GwemmeN Fuiarice
INSTRUCTIONS:
Form ed th:
To 6e (ied in person or by mail with the CountyAuditor or Counry Recorder o/ fhe county wFiere fhe property is Iocat�lAY �.
FiNng Dates: 1) Real Pmparty: Must lile durirg the year for which the deduclion is soughG Counry Auditor
2) Afo6de / Manufactured Hortres rat assessed as Real PropeAy: Must file dunng the fweNe (12J marths
befo�e March 31 of each year Ihe deduc}�on is sougAt � Counry Recorder
See reverse siCbfor addiWnel insLuctions and qualificat'pns.
isvfa Ker n,mecr r al «aiv�on
� —II�
sessep rdh�e d mal qop¢rty as of Mor�age/ Contrac[ i
ert� 1. anml Y� MerM 1, arte�rt �
M. wh3l LS hi5 / hC PYHf15h2l8 Oi 1I11¢RSl?
name m remtl is Q�Iferent lhan that of aPP�^^� ind�te Eelmr.
I 1
ame of mortoaaee ar mntract seqer
a�oo. ss -oa .��.µ.To � �°V � 43 �
o unpaid as of Mongage I ContraU hMeMedness unpaid as W Is Ne appfrcant Ma sde
Cate af appfifaLOn legal a equitaNe awneR
�� ❑ Yes ❑ No
someone dhm ihan sCa+�. iMimta riM wMm
nprtgagce or mntraa seAU (numbal end streeL uN. sfete. aM LP code) .
Name W assignee or oNer avmer
AOtlress ot assignee (numOer eM stree4
Oces epplirvnt rnm property in any aher I If ym, what munt�/?
munryin —" � _^-.._..�� No
Draty�r r - cou
o�� t10.���p.......
z Card 1Vp 2Q zo
...... s�. �., J... ... ,
urd r epenany..�
act of the afa
Wl�at Taa(g D'¢bict7
p
IS ihe V�PertY in Ouestim: Mm�aM A.sessed
❑ Reai Pmpenv ❑ %vmuaM Auessed
yeaR
�o _
requesteE on pinperty
❑ Yes ❑ No
�
I�nry,�;�;t���� I�� (�Y �I I l J
� . �regoing intormatlon is true and cortecl arW Nat Me applitant is a resident of Indiana and
PertY cn� ....� appluatlon is filed.
oate (monN. daY• Y�A
and sbee4 �Jy sAfe, �nd LP code)
AEdress af aWmmeE persm (number arM svicet �'m: sta�e, and LP code)
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