HomeMy WebLinkAboutMortgage_Blaize (4)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownshi vear
• FOR DEDUCTION FROM ASSESSED VALUATION
.• — " sm�e F«m a3�os �a» i sw>
•S i p��bed M Department oi Lod Gmemnrent Firwce
Fle Mark
INS7RUCT10NS:
To be fi(ed in person a by mail wrfh the CountyAuditor or Counry Rerorder of the county where tlie property is located.
Fdirg Dates: 7J Real Property Must file dunng tha year for whicli the deduction is soughG C �tp�
2) Mo6de / Manufactured Homes not assessed as Real P�operty: Mus[ fife dunng the fwelve (12J months
6efore March 31 of each year fhe deduclion is saght. ❑ Co er
See reverse side /or additional inslrt2Gons a� qualifications. G�B
MM�� (o or,canfraC 6vyu- seArcS➢ct°^s m leverse sid�j f/J ' _
ro,
—� -���-Q��� 0.1�—
Mo�age/ Contrarl4itle6teaness unpaid a of Mongage /(
Mardi 1. curtem year date of app0
tt awned with someon
tt`wrie m 2mN iv GAferan Ihan ihat ot aDW�C trtlicate bebw:
Name of martgagee a mntract sUler � n�
(Y
Add2s ot rroft�jagee w mntrad seller (number and svea4 cill: te.s a�code)
Name at assi�ee w other owner w haldu N mwtgage
AEtlress of assig�e (nvmbe� aM stree; ary, state, end LP mde)
Doas epplifant ovm property in any oNer If yes, what muntyl What Ta�dn
munrymind'vna? � Yes ❑ No
COUNTY AUDITOR
Deaucfian apptwed'v� tlre artrount ot
zo_ 20_ zo_ zo_
s�mre o� c�� nw��w ca�r
�pS �O .J P�Of �/ /�
; unpaid as d Is �he appGrant the sole
� kgal or eQUitahle oxTwYl
❑ Yes ❑ No
IM'�te with whom
property in question: MnuaM AssesseA
eal P(Operty � Hrmually ASSessed
Dra�ti�er 1ioa�3
Card NO. .....� 7 � �
m praperry
I I We certy under Ne penalry of perjury Uiat the above aM foregoing infortnation is true and cortect aM ihat the applinnt is a resident of Indiana aM
owner I contrxi buyer of the aforementioned property on date ap�ration is filed.
/ Sigfa¢ue ) Dale (rtiaNi. daY• 1'ae�
n�
/\ residen ed ess of a t(number and sbee4 �1: ��e � LP cotle)
X 7s��. �� � s��Y
Pr1:un autnwaN by dWy ezecuted Power of ntmmeY ar q iC 6t.t-72-0.7 Da'� (mwnl+, daY. Y� ._
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