HomeMy WebLinkAboutMortgage_GlotzbachSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
• FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 93709 (R11 / 6-09)
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File Mark
wsrnucnorus: NOV 2 9
To be filed in erson or b mail wifh the Coun Audito� or Coun Recorder of the coun where [M1e ro ���
P Y h' �Y b P P�nY is locared.
Filhg Dates: 1) Real Property: Must fife during the year for which the deduction is sought. C.!�. Counry Audimr
2) Mo6Be / Manufactured Homes not assessed as Real P,operty: Must fi!e dunng [he hvefve (12J montfis
6efae March 31 of each yea� the deduction is saght. County Recorder
See reverse side /or additional instructions and qualifications. G I BSO N COU N
I MP��� (owner w mitrarl buyer- see �stnrtiQns m reverse siee).
Taarg Dis " Key mim6er /
mi
-5
sed lue of rpal pmperty as of M
Metd� 7. q]rent year M
Ir no. what Is his ! her erarl share ot interesl9
It name on remd's dAtern�t than that of aPp6pnt, !
Name of morigagee or contrarl seller/�
nnaress of rtaRga9� «m,o-aa se�e� (�urt� en
Name oi assi9nee or otlres owner or holder of rtqrtg:
PLCress ot asag�e (nt+mber aM s1ree4 dry. s1are.
Dces ePP��nt wm property in eny oNer
counry in Indiana? ❑ Yes
❑ No
pe�� praved'o� the amounl of.
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$kJ112NR O( Caw11Y Audf�W
,���
-/O.J-LVV (OOCJ-
Contraa irdehtedn�s unpaid es ot
�R ciN, sta�. ard LP code)
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nd LP cade)
IF yes, what Counl�t
co r
zo zo
Remrd numbr+
Mongage / ConvaC We6teCness unpaid as of
tlate o( appOfatbn
someorre oNU Nan SPOUSe. hMirate wiTh whom
the ProPert1' in QueS➢t
�� �PenY ❑
/ p, �\` �� �O �'
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Yes ❑ No
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I/ We certify under ihe penalty oi perjury that the above and foregning infomiaUon is We and cortect arM that the applinnt is a tesident of Ind�ana and
owner I mntract buyer of the afo�emefAioned pmperty on date appliratlon is filed.
7fahue (owne/s h� name) Date (monfh. daY• YBa/)
! SL. - - . _ .a. �' (1 t = �.. � .. �,-. \\ / Z9 / \ 2
stdte, arM LP
a
ofaWraaedprlson (numberarMSbee4�Y.s+a�e.eiELPcade)
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