HomeMy WebLinkAboutMortgage_Evans (6)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ownship Year /
__ FOR DEDUCTION FROM ASSESSED VALUATION �
� Slate Fwm 43709 (R71 / 6-09)
�' � Resaibetl O1' DeV�nt o1 Local GovemmerR Fitwxa
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INSTRUCTIONS: c
To be filed in person a by mail with the CountyAUdito� or Counry Recorder of the counry where the pmperty is located. J
Filing Dates: 1J Real Property: Must file durirg the year Por which the deductlon is soughf.
2) Mo6ile /ManuFadured Hanes rrot assessed as Real Pmperty: Must file danng the M1veAre (12) months C
6efore March 31 of each year Ihe deducfion is snught.
See reverse side fo( additional instiuctrons and qualifirations. G I B SON
Appfuant(owneroroontrae�buyer-sffresni-borumre�(yesideJ )
Counry Audiror
6ounry Recorder
Key rwm6er / legal desaiGtion RemN number Pa9e num0ei
,� -/e1-07 - o/-000. D 5 V-o �-8 a. SS�
qoper[y as of Mortpaga / Contract inde6tr�ness unpaid az o( Mortgaga / ContratY @dehtedn¢s �mC� as d Is Ne eOP��t tlu sde
March 1, artent year dare of epP�cation legal or eQUitade owixR
53 QQ� ❑Yes ❑No
?xaG StuR Of intere5t? If owneL wiM sortwane other Man smu•e. iMi�te WM wMm
If name an remrO ¢ Eifterent Nan that o( appbrant, cidicate Delow.
Name W mwtgagee a contract seller
Address o( mortgagee w contrad
ovmer w naaer at mortgage
Adtl of atsignce (number arN e; rSy, e, arM% P oo�e)�
Ct/IJ�' �/
Dces epplk2nl wm pmperty in any oNer . I( ye5, xltal munly?
muntyinlnEiana? ❑ Y�
❑ No
�a��
DeducUOn approved in ihe artaunt of:
20 20 20 20
Is property in 9uestion: Mnua�Y �55eG
Real PmPeNY ❑ A"^ua�hl0.sse��
Mobile Fbme (IC 6
DI'a1YCI' �iQ... �.�, .
W�a�TaringDi Card NO. ...�.�5�
�3;�Q �� .........
20 I 20 I 20
Signature d��mry� I Counry I Date (monM. eaY. Y��)
I I We certify ufWer the penalry of ury that Ne a anE toregoing intortnation is We and cortect arid that Ne applinnt is a resident of Indiana antl
owner I contrad buyer of ihe aforementioned prope on daffi applicatlon is filed.
SipfaNre (owne/s�'ameyj Date (nrnN. daY. Wa�
Person
sbee4 dN�te, aM Z!P oode)
person (numberaiMSbee;cily,SYdta,arMLPtotle)
�Y, Y��