HomeMy WebLinkAboutMortgage_Rogers� �a.� �'� �
^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ - FOR DEDUCTION FROM ASSESSED VALUATION ��
• Slata Fwm 43709 (R71 / 6-09)
,' j PresrnbeE M�P��ru ai Lnral Govermient Frw�ce
File Mark
INSTRUCTIONS: y ,n
To be filed in person w by mad wiUr the CountyAuditor or Counry Recwder of fhe counry where th�{�erty� Ib���.
Fd'ag Dates: 1) Real Pmperfy. Must file durirg the year lor which Ne deducfion is soughG
2) Mobi7e / Manufactured Homes /rot aaesced as Real Pmperty Must file dunng th�haNV`�(�s
6efore March 31 of eacA year Ne deduction is soughL �
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inshuctfons and
If M. WhBI IS h6 I h¢! BYdCl ShdIC 0( IfItCRSi�
ttnamean
rtartgagee «contrariseller
�ge ,��U
Ma`tli 1, wrtent year
Pddress of mort9a9ee ar mntract srAer (n�n�bri end stree; cGy stam.
Name W assim+ee w
AEtlmss af assignee
awner w tpWU of matgage
licant awn pfoperry i^ any other
Indiana? ❑ Yes
c+. trra
GI ON COUNTY
D
l dc� �� ��,�'-oo �
dyyteEness unpaid as of Mortgaga / Contract IMetr
� \ /oO� dateofaPP���
H uwfed wi� someone otlwr tlian s�
cade)
Fam filed with:
(�unry Aud'rtOr
❑ County Recordu
as of Is Ne eppGrant the sde
legal w equiFaNe oxm�1
❑ Yes ❑ No
wfHi whom
h U�e property in Questian: Mnua�j Assessetl
� Reai Property � Am1UaIy 0.55essed
Sted m P�Y
Yes ❑ Na
GOUNTYAUOROR
DeaucGon approved 4� ihe artrounl oE
20 _ 20 _ 20 _ 20 ZO _ 20 _ 20 _
Sig(qwre d CamN nuairor Caw+ry Da;e (monM. da1: iTa�
I/ We certify under the penalry ot perjury that Ihe ahove and foregoing infortnation is true and cortect arid thal ihe applinnt is a resident of Indwna atW
ovmer I wntrad buyer of lhe afo2mentioned property on date appiiration is filed.
Ipnature (owneh htll name) Date (month. tlaY. Yae�
F ent adtlress of umbereritl sLee4 ary �te, eres LP oode)
%80� S Fr%IIo�„hroo�. o,�ensvil�e �(e .5
Pcson autlwmed by OWy eaeaitetl Power of Attumy w by IC G7.1-12-0.7 Qate (month. Eay, ya�
Address of aufhasse0 DQ« inumbe�entl sneet �l: state. arid LP code) .