HomeMy WebLinkAboutMortgage_Coleman (4)�\,
X
^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
,__ FOR DEDUCTION FROM ASSESSED VALUATION
r. • Stata Pwm 43709IR71 / 609)
4' f Presai6ed by Departrnefrt o( tnml Govemmenl Fitance
w
File Mark
INSTRUCTIONS:
To be filed in person or by mad with the CounryAUditor or Counry Recorder o! the county where the pioperty is 1 ted.I Fam w�
Fi/irg Dates: 7) Real Pmperty: Must file dunng the year lor which the deduction is sought. Auditor
2J Mo6ile / Manufactured Homes not assessed as Real Property: Must file dunng the M1vefve (72) monfhs
betore March 31 of each year the deduction is sought. S E P 2%4O ��°Unry Recorder
See reverse side for additional instructrons arid qual�ications. ^ �
App&ani(mnreroroonlraC6vye�-seerestriq!iunsrnreversesidel A .V..
- 40/- Doo, 6 ao -oo
�������
t, �r�eN year
Ii ro, what is his / her eraU share of inte�est?
If fume m remd is tlttfuent Nan Nat o( appGpn4 mdicate Ge�ow
Name ot mortgagce or mntracc sener � � l. �
Address of rtior[ga9ce or canbact se�er (numbei aM sLee; cky, s7ate, ard LP codej
Name of assiryiee w other ovmer w hdder of mortgage
Ad02ss ( assgnee (number aM street �Y, s+a1e, a�
�-t T
Does applifant own praperty in any oNer
munryinlndana? � No
❑ Yes
���������of
2�_ 2�_
wmbrl
date of avP��?� kgal a eWltaNe oxndl
� O U [� CJ O ❑ Yes ❑ No
If awned vriN someorre othe than spouse, indifata Wih wlwm
COUNIYAUDROR
2Q _ 20 20
Counry
Is Me ProPenY in OueYim: MnuaOy Asessed
�R—eal ProPertY ❑ Mnual�Y �
D�-��,����.io....a01 �.
C81'v ,\'�. ...` ..<../..........
� /01, ct�.Cti ........
zo i �
Dale (�. daY• Y'�A
I/ We cerlify under ihe penalt�ot perjury Iha above and foregoing infortnation is we and correct and that the applirant is a resident of Irrciiana arW
owner I co tract buyer of ihe aforem 'on roperty on date appiin0on is filed.
Sigraw u e/s hA Date (rtprvh, daY. Y��)
' ent adOrass r 4 , state, aM ) �
�
Person a ey aWr exen,tea aorer anorney ar q F7.7-1z-0.7 oate (rnornh. dar. r��
AAd�ss of auNMZed person (number arM svee4 �: �te, and LP code) .
4�