HomeMy WebLinkAboutMortgage_Boger"'�0 STATEMENT OF MORTGAGE OR CONTRA��TYN�E� PI Coum
�_ • FOR DEDUCTION FROM ASSESSED VALUi4Tl
' �8�'���`�„��> NOV 7 2012
� � Presrnbed M DeP�N of Lxal Gavemment Finance
u�.
INSTRUCT70NS: C .�J �
To 6e filed in person or by ma�7 with the CowryAuditor or Counry Recader ot the county where is located.
Fr7irg Dates: 1) Real Properiy Must file durng fhe year fir which the deduction is� �o�q�y, N7Y AUDI70R
2) Mo6de /Manufadured Homes rrot assessed as Real ProperffclQ�Nh7e`Uli�g the tvmlve (12) months
6etora Marrh 31 of each year the deduUion is stught. -
See ieverse side !or addrtional instrucUons arrd qualifications.
%W (o artonlraC 6uye� - see restn'�'ons m reverse siie)
File Mark
Fartn Aed wiN:
� CounryAuditor
❑ Counry Recorder
Ta�d`g D' ' Key manber / legal desaiption Remrtl numb¢r Page number
- -� cr� 70 o a a oi a y s'�rd
� �� p�ty es of Mortpage� � tetlness unpaid az ot MMg (g�e! � aG IMebteMess unpaid as M Is Ihe eppGnnl ihe sde
Mardi 1 ,,^�, pp legal w equitahle v.meYl
� q (JCJC_J ❑ Yes ❑ No
Ir m, what Is nis ! trer erarl share of
If name on rem�d's d�Remn[ U�an tt
Nartie of rtart8a9� a
Address of nqrtga9ee w
DOCS E
munry
Oe�ucaon
ewner or rwwrs a� rtwcgage
)er8rld5tJeeG �: state, anc
ry in eny o�her
es ❑ No
amountoY.
�
�y; sb�. arr0 LP mde)
H awneO wi� someane dhei ttun sPO�. kdicate wRh wham
Is Me property in ques0on: MnueM���
❑ Real ProPertY ❑ Nmuaihl Assessed
A1oW'le Fbme (IC G1.1-i
� Dra�ti�er•i\iO..Q�Qf
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� CaCCl 11'�: .. � �
Wnattan " ••••••..••••
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P�P�Y
❑
20_ 20_ 20_ 20_ 20_ 29_ 20_
Signawre W CmmN Aud'rtw Counry oate (nmfh. dav YEa�
I/ We certify under the penatty ot perjury that ihe above afM foregoing infortnation is true and cortect arW lhat Ne applicant is a resident of Indiana and
owner Iypntra�l,b�reraf-t�e aforementioned property on date application is filed.
Slpre4u�o name) Date (rt�w+fi. daY. We+i
sheef, a7}; stdte, aritlLPoode)
[!
y�a�
Pdtlmss N authoraed per'.m (number and sveet cih. sbte, eM LP oode)
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