HomeMy WebLinkAboutMortgage_Richardson (9)^'3 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun o ip
. • FOR DEDUCTION FROM ASSESSED VALUATION
. State Fortn 93709 (R71 / 6-09)
� •�` Prescribed by DePa�m af Loral Govemmenl Finance
�� F�'q@�'�5 2012
srRUCnoNS: �,
To be filed in person w 6y mail with the CountyAUditor o� Counry RecoNer of the county where the property is located. F�� . ���
FiNng Dafes: 1) Real Pmperty: Must file durng the year (or which the deducGon is soughL � ����y p„ �
2) Mo6Ae / Manufactured Homes irot assessed as Real Property: Must file dunng the hveNe (12J months �'1 �f �
before March 31 of each year the deduction is s[uyht. G BSULN C��Q'1R�OR
See reverse side for additional instn�ctions and qualifications.
Applrent(owp�alcorifrarl6uyer-see reve siY ) /� /)
I
I'
Y mal ptop2rty as
1'�
If no, what "s ha / her exar� share of intrlesl't
artent year
It name on remd'a ddferent tlun fhat of app6can4 Nditate below.
Name of rtqrt9a9ee w
AGdress of ass�ee (number aM streel, rity, state, antl ZIP catle)
Does appli�nt pvn propnny in any oNer I 1( yes, w
munlv in Indana? .—. �
icGOn apprwea m me amount or.
20 2o zo
If mmed wiih
legal or equita6le oxnM
❑ Yes ❑ No
i`d'cafe wmh vAnm
IS Ne ProGP�1' m QueStm: MnuaDyPsse55e0
� Real Pfoperty � Amlually A55es5ed
, 2��� ...
D,�:�„ ��-,o....... �5�
3 . ....
Card N 21 �S�D ���j ..
Counry
nt yeaR
_o
reQUested on P�WenY
❑ Yes ❑ No
o�� c„b,�w. ear. r��
zo
I/ We cert'rfy under the penalty oi perjury Nat ihe above and toregoing intortnalion is We and wrtect and that the applirant is a resident of Indiana aM
owner I mntracl buyer ot the aforemeMioned property on date application is fited.
I�dBlovmery hA narq) � . / Date (moritlt, day, yea�
.7!/J L� �rr�.re%•ran !-�/'. /%' �/I � ci
Person authw¢ed Dy duty executed Poa�er af Attomey or by IC 61.1-12-0.7
Pddress of autharrzetl persa� (number antl sbee; ary, stafi,
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