HomeMy WebLinkAboutMortgage_Ross & Company�
""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS �u wn ' vear
_ - FOR DEDUCTION FROM ASSESSED VALUATION
� s�a w� a3�os (a,i � s-as)
,�' f presm3ed by �epartment of Lxal Govemment Fnarxa
File ark
INSTRUCTIONS:
To be filed in rson w 6 mad with the Coun Auditor or Coun Recorder o/ fhe coun where fhe ro �����
ae Y b N N P ae�N is rocated.
F�1irg Dates: 1) Real Pmperty: Must file during tha year for which the deduction is soughL �� Auditor
2J Mobde /Manufaclured Homes rrot asseued es Real PropeRy: Must fiie d'uing the fvreNe (72) months
betore Mamh 31 of each year the deduction is soughG ❑ n er
See reverse side fwp�d'tional inshuctbns and qualificafions. G I BS
buyer- see re:
� �
�y
�������
Ma�rh 1, aQmtl year
that of
Name M rtnrfpagee or contraG sellu
nmrea or nwn�ayce «m,o-aa
awner
- 3--� ��' aoo. i�'-O� �
Mo�ag e/ Contract IntlehteEness unpaid as ot Morigage / Con;ia
Mard� 1. curtent Y� tlate of app0�ation
(number aM atreeS �}: slate,
saaeL �l: �.
s
Ooes eppf�nt wm p(operty in any oNer I I( yes. what countyl
counryinlndwia? ❑ YES ❑ No
20 I 20 I 20
20 _
si9reaue ot co�u:b auEanr
I I We certify u`xfer Ne penalry of perjury that Ne above and foregdng inf
owner I contract bUyer of ihe aforementioned properry on date appliratior
Signature (o�me/s hm rema)
�
F�ident addrnss W a t(numberand sbee4 dry, state, eM LP mtle)
Q -
Person author'¢ed by dWy exewted F'ower af Atmmey w by IC 67.7-12-0.7
Address of auNa'vtd person (numberand sbeel, fify, sfate, end LP code)
wYJi someone oMu
WhatTadng
rtewm numorJ
Q05' �' `�
unpaid az W Is the applicant the sole
legal or equita6le o.mM
❑ Yes ❑ No
idkate with whom
pmpe(ty in question: Mnua�y Asesed
�I PfoPeri' ❑ H!?iva�yAssessed
Nas Ihis de0uction Deen requesteE m P�Y
tor artent yeaR
❑ Yes ❑ No
i rnq
Dra�r�er NO. ...W.1.......
�: �" . . � .. .
c���a .io. :. 7a'�..-.........
'31 ��I l.l..li• iQ
zo
Indiana and
V