HomeMy WebLinkAboutMortgage_Richeson (7)^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
� Sbte Fwm 43709 (R71 / 609)
�` „„ � Prescibea oy Departmeru of L.oca1 Govemmenl Frence
II
INSTRUCTIONS:
To be filed in person w by mail with tha CountyAUditor or Counfy Recorder o( the county where Ihe property is located. F�' ��n ��
Fi/irxJ Dates: 1) Real PropeRy: Must file dunrn� the yrear fir which the deducfion is 5ought. O T t71 ����, quditor
2) Mo6de /Manuladured Homes not assessed es Real Property Must file dunng Ne tweNe (12) rtanths L1'J'1�
6e(ore March 31 oI each yevr the deducfion is soughG C'�. nLl '�Cpunry Recorder
See reverse side (or additional instnrc ' ns aM qualfications. � v
qp t(awrermcm7raabuyer-see mreverseside) GIBSON �
�
T Distr"vY Key nm6r+/ legal desaiptian Remrd munDer Page number
a..e� a-,Y_ ��- lo�(-DDO. �j' ��-vo7 aoo ���Y7
AR¢sed rdue oF real a d Martpa ge / Contract 4Webted�ss unpaid a5 d Mongage I Con� udehtedness unPaiE as o( Is Ihe ePP��t the sde
Marrh 1, au�ent ynar Ma� 7. wrrent year Eate of ePP�� .� legal w equitade amer/
I� fq. wh3� 6 h6 / Mf OXdGf 5112f8 OI II1iPR5il
It name m�emd is Eitterent Uan ihat of appfirant, uNipte Delow
rUme o� rtwtgagee «cw,o-ad sener
Address of rtiortgagce a contracl se0�
Name or assignee «oNU owner or h
ALdress of assgnee (numDer ar�gfi
Oces ePpMant o+m property in any oMer
munry m Ind'ana? ❑ Yes
Deduc6on approved in itre amounl of.
20 _ -�
I/ We certify untler Ne penalry
owner I contrace buyer of ihe a
X Sig (a hmna •
,
� FW 'tlent 4'rrss of a i
ot authorrsed cerson
��.
rtqrtgage
tir°, and LP ) /-
f �/
If y�, whal munpR
rc anre0 xritn mmeone
1�.•i�
Ia[�I�11[�I:7
� q ❑ Yes ❑ No
spouse. 4dicate �WNN whom
�Is ihe roperty in Question: MnuaOy Assesstd
�ai �ro�m ❑ iw,�iy ns�ea - . -
_'. �
__ _ � �
�� a tirer !\' p,..(JI�(/�
•T,.....
C� t cl !�`�. ... � y 7 • .
_ � "�•'••.... .
d
20 _ 20 20 _ 20 _ 20 _
Caunry Date (monih. daY• Y��
that e Dove arW (oregoing infortnatirn is we and correc[ aM that the applinnt is a resident of UWiana arW
n perty on date application is fiiad.
���.�Y��,
M
CJ'�
Y��
lO�o �
,\
�