HomeMy WebLinkAboutMortgage_Price^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE Coun Tovmship vear
_�_ _• FOR DEDUCTION FROM ASSESSED VALUATION ��
State Fom 43709IR71 / 6-09) � �
S , Htsmbed M DeG�erd af LoW Gwemrnent Firw�ce
File Mark
WSTRUCTIONS: ��(' 4 't���
To be filed in person or by mad with the CounryAuditor or Counry RecoNer of the cour�pCiopere the property is located.
FBir�g Dates: 1) Real Pmperty Must fite during fhe }rear lor which tha deducfion is soughf.
2) Mobile / Manufactured Nomes not assessed as Real Property. Mus[ fif�d0iR�4fie��2) monfhs
befwe March 31 01 each year the deduction is sought. -
See,eversesida/oradditiona/instructionsarMqualihcations. C��N'(Y AU��j�R
AoaGUn� (owrrer o�confract bwu- see 2sbictiuns on 2Yl:rse sidel .
Fortn Aed wiN:
Ry CounryAUditor
/'—'
❑ Counry Recorder
Key manhel / kgai desaiption R¢mfy nump¢r Page numbel
a- -Z - �o� aaa o a a� � a ,5 �a 9
praperty as d ga / Contraci irdehtedness unPaid as ot Mwtgape / Con'vafl mdebtedness unPaid as ot Is Ihe aPD�� the mle
7, aurent yeN date of aPP�� legal w equit261e o�meR
��O i�OC� ❑ Yes ❑ No
�
If name on mmrd is ?dferrnt tlian that o( app6mnl, 6Mirata bebw:
NameotmortBa9ee
omer ownu w naaer ot rtartgage
�,
n0are:s ot assynce (numcer aria 5vEe4 �j: Slafe, ena ur coOe)
Does aPDlinnl rnm property in any oNer
munry in Ind'ana? ❑ Yes
De�ucCOn approved in tlre artrounl of.
20 20
S'ry�aaMe d Camb nudP.ar
If yes. what munry? � J �,
{��
20
20
atwl than sPO�. cmdKate Wm whom
Is tl�e Praperty in quesron: MnuaM Assessed
❑ Real Properly ❑ Nmualy Assessed
MoW�e Home (IC 6
P�-� s�A �
��� �
i� -s��y
20
20
�
20 _
I I We certify urWer Ne penatty ot perjury that the above aM foregoing intortnalion is We and cortert arM that the applinnt is a resideni of Ind�ana a�d
owner I contra�Y buyer of the afaementioned properry on date applintion is fiied.
NaWre (avme/s hdl narr ) n Date (rtwntli. daY.l'ae�)
RA �evGent e0�r ot appYmrt (nurt�frantl sLee; tity, state, e
� q0 5 S In7,5 u/ OwvnS�
Person autharzeL by dWy execu:etl Power ot Attcmey a by IC G
Adtlress of aW�a'¢ed puson (numbe�antl saeet �: s+zfe, end
Qate (monN. daY•