HomeMy WebLinkAboutMortgage_Purkiser"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T hip ��
_ � FOR DEDUCTION FROM ASSESSED VALUATION �
� StateFartn43709(R71/609)
,' ,µ PresaibeE �y DepartmeM of Lnml Govemment Fna�rz
�vsrRUCnoNS: F�C�L�a`�f s ���2
To be filed in person w by mail with the CountyAudito� or Counry Recorder o7 the county whera the property is focated. F� Q�• ,, '
Fifirg Dates: i) Real Property: Must fJe durilg the year for whirh tha detluction is sought.
2) Mo6�7e / ManulaGUred Homes irot assessed as Real PropeRy: Must file during the fwelve (12) months �unryvudAw
n O_� \_'
belore March 31 0! each year the deduction rs sought. G BSC�J C�'Otl^�' .,"�'OR
See reve side /or additional inshuctions and qva/fications.
b�- see mst� m re�xrse sCe) .. �i ./� `
assessed vaare ar r� aopercy as
Mardi 1, arreta year
If m. what Is his! her exatl shara of
r/legaldesviption / /
�^Ob- I 00�
e/ContraU"cdM
1, airtent yraf �
It name m femC's tliRerent Nan ihat ot applkant, inGicate below.
rvame ot rtrortgagee w mntraa
Address of mortgagee w mntr
Name af assignee w othel avm
rel antl sfreeL dty. state.
�9�J��
' as�gnee (rwmber aM stree4 ury, state, an0 LP code)
nnt wm property in any oUer If yes, what munt�?
iWiana?
❑ Yes ❑ No
apptoued'v� �lu amount of.
20 � 20 _ � 2p _
R
���r.�
iMeCtedness �mpaei as ot �«ew�d� v«n�1
❑ Yes ❑ No
tt owneE wiN mmeone oNer than spouse,
Is ihe property in QuesGOn: MnuallyASSessed
❑ Rea� Property ❑ rw,uany Assesed
Has Nis detluUion been repuested on propejly
���� ❑ Yes ❑ No
COUNTY AUDITOR
20 _ 20 _ 20
Caunry D
2(1
I/ We certify urWer Ihe penalry of perjury that the above anA foregoing intortnation is true and cortea arW that the applicant is a resident of Indiana aM
owner / mntracl buyer of the aforementioned property on date application is filed.
�nawre h�Ormme) �/ � � Date (mWh. daY. Y��
slate, erM LP mtle)
autlrorized Dy dWy ezewted Power W Attort�eY ar Gy IC E7.
person (numoerarMSbee;ury,state,endLPCOde)
Date (nromh. Oa): Yaa�