HomeMy WebLinkAboutMortgage_McKimmy^'n ' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year �
_ • FOR DEDUCTION FROM ASSESSED VALUATION
Sfate fwm 43709 (R11 / 6-W) � A��
�' y� � Presa�bed by �ePartment a( Laal Govemment Finarcx �
g File Mark
INSiRUCT10NS: F� �� �:
To be filed in person w by mad wifh the CowtlyAuditw or Counry Recorder of the ca�{ratx �yhg{e,(he,�q{pperty is located.
Filitg Dates: 7) Real Pmperty: Must fJe dunng the year (or which Ihe deduction is s8b(f1! � i5 Cu I C �Counry Auditor
2J Mobde /Manulactured Nomes rrot assessed as Real P�nperly Must Ae during the hveNe (12) months ❑
6efora Ma�ch 31 of each year the Aeduclion is sought. C_�� Couniy Recorder
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See reverse side for addrtional insWCGons and quzlificat'ans. �
no�ramtownerorcanaawb�iA�-seeresu;criwuonwv€kesidel. r.iacnN c:0UN7Y AUDITOR -�
As.se�ed rahie of real pfoperty es of
Ma�tl�t,�vrentyear
If m. what ts his ! her eraC share o
�i flMlf d1 IECMd 6�iiORfli Ii13l1It
�Y��I��D� �VY'—OOv.JO�—C./ Remrdnu��� P�Bn��O�
Mortpage / Cantract indehtedness unpaid as of Mortgage / ConvaG inde6tedness unpaid as d Is ihe eppGOnt the sole
MaiU 7, arrertt data of app0�atnn legal w equitable ame(.�
�OOO� ❑ Yes ❑ No
trlestl tf owneE wf,h someone other Ihan sPO�. IMtcate wiM whom
Q1dltl}2 bC�OVf.
Nartre W rtnrtga8ee v contraG se9er
Addres N rtnrtgagee ar mnhaC seUer (n�� r
Name of assi�ee w other owner o�
sbee;
Addfess ot asvgnce (numbe
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Ooe^ applicaN oxn p
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I I We certify under ., penalty ot p�ury that Ne a ve
awner I con4act buyer of ihe aforementioned pmp o
�fia'.W8(ownE(5/t�ll3me) e . �
Persw, auun�'vte M attlr esa,:ea
Pddress of auNOrrzed persm (num
Is ihe P�Pen1' in OuesGOn: MnuaDYAssesseG
❑ R� �roveM O a,��Mw�
:dudian Deen requested an P�Y
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20_ 20_ 20_ TO_
��(y Date (/rpnih. daY Yea�
foregoing infortnation is W e and cortect arM that the applipnt is a resident of Indiana aM
te application is filed.
Date (rtmth. ddY. YBa�
state,aMLP e)
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