HomeMy WebLinkAboutMortgage_Fisher"'�+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year �
• FOR DEDUCTION FROM ASSESSED VALUATION
� sr�a r-om a3�os ptn i s-os> JL
S u„ l Presmbed hY aP�eN ot Lod GovemmeN Fuiance
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INSTRUCT70NS:
To be filed in person w by mail wrth the CourrtyAuditor or Counry Recorder of the counry where the piope FO� fl� "'�':
Fifi�g Dates: 1) Real Property: Must file dunng the year fir which fhe deduclion is sought. �� Z� Counry Auditor
2) Mobile /ManWadured Homes rrot assessed as Real Property: Must file dunng the fwelve �i�2
before March 31 0l each year the deduction is sought. � County Recorder
See reversa side Tor additional insfixGons arM qualifiqtions.
Ma�� (ownera contrart buyu' see resvicnons on rewerse side) . . R
�
Martli 1. arrent yrar MarM t, wrtem year
i3syoc
If rw, what Is his / her e�ct share ol interest?
tt riartie an rewrd's 69erert Nan Ihal ol aPP�l'u�dHate Oebw:
Name of moh9a9ee w mntrarl se0er F/�
�.l
Address of rrort9a9ee ar mntrad se0er (numbe� and sbee; ra}; state, aM i
Name ot assignee or othr! owner or hdder N mwtgage
AEtlress o1 assi9tree (nurtNeraM skee; tlfy, slate, an0 LP pode)
Do¢s aPplimnl own pmperty in any oNu Ii yes, wha[ mun17/1
apprma,'d h� the amount ot
20 _ 20 _ I 20
�nue w Cmmb a,drt«
RecoN num0er Page numbei
o�/ aoia 55�y
:ontra-t' ebtedness unpaid as d LS Ne ePPG�nt tha s�
Y� u r,o
spouse, i�inte wltli whom
is the ProOeM in 4uesfion: anrwa%nssesse0
�al RopertY Q Amnially 0.sse55ed
'7" nnodie � nc s
Dra�ver NO...G��I� .
� .; �. , ..
��T� . . $y.y8
C8I'v 1�`�. .......:..
worro `l��3Sypp, o0
Y
20_ � 20_ � 20_ � 20_
I/ We certify under the penalry ot perjury that the ahove arW foregoing infortnation is W e and cortect arM that the applirant is a resident of Irrcfiana a�
owner I mntrad buyer ot ihe aforemefrooned property on date appfication is 51ed.
�^a4Ye (owne(s hdl n Date (rnaRh. daY lga�
F�ID resitlen�ddres ol appOCant (numDer antl shee4 aty, sfate, arM Z1P cd
x G�i7 u� �v���.-o �. �.�
Pelson auUw�aeE Ey dWy execvted Powe f Attm�ey or IC fi1.1-12-0.7
7e5M (num0er sntl sbee4 �: sfate.
Il, z� �t 7l� � 5
_ : Date (mw+th. daY• Yea�_