HomeMy WebLinkAboutMortgage_Coleman (2)"'nv STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
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• FOR DEDUCTION FROM ASSESSED VALUATION
sr�a rom, aa�os (an i s-0s>
�' ,,,, � Pfesaibetl M DeG�ent of Loral GoremmeN Fuw�ce
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INSTRUCTIONS:
To be fiied in person or by mad wifh the CowrtyAuditw or Counry Recader o/ the wunty where Ihe property is foca
Fdirg Dates: 1) Real Property Must file durirg Ne year Por which the deduction is seught -� Counry Auditor
2) Mobde / Manufadured Homes rrot assessed es Real Property: Must hie dunng the Nrelve (12) months
6efore March 37 0/ each year the dedudion is sought N V� Z��b R��
See reverse side for addi(ional instructions and qua/ficafions. C
MP����owriern or'mrm-ad iyrer -see rcs�n' (�m rewrsne s�ed-e)4 _— /j ..... __ •
j!f TI.C.tA AX f .%� �/i �.�/'L�./W �l � �� . . �
-/f - /S-
tt ro, what is Itis / her eraa shara ol interrstl
If name on record is ddferent Nan Nat of app6mnL �dinte helow:
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Address of mort9agee or contrad setler (number end sn
Name of assignee w other ownu w hddaf of mortgage
AdE�Ess of assgnee (numbe sheeG dry, sfate,
d
Dces ePDli`ant property in any o er
munry in Ind' ❑ Yes
❑ No
Or�ucrion aoorove0 tr� the amount af:
�
� - r - vn
I/ We cerVfy uMer ihe
owner! contract buyer
20
_ p0�, `� 8/0 - v �17 ( 2.
�tetlness unpaid as of Mwigage / Con;'aU mEebtedr�ess unpaid �
date of appGntion
SO D O7�
tt owned wi� wmeone other n�
Is ihe orocem in
ee; cRy, SFdte. arltl LP coEe)
LP w0e)
�c� � �
It yes, wha[ muniyl What Ta�dng D'e
20 � 20
tha�e above and foregoing intortnation is true a
n ProGenY on da[e aPP6cation is filed.
37
ves u No
.J2t�l"Z J �
L�,.-�� h�,rw �� C��ir.n���
`�' �/i� CC'�: �N
C��n��n �m�����un
�FUO W app0�ant (num6erenE sbeet �1: sbte. end LP e) •
$13 S Whi�t �hv�Gh � ��ittc.t_�on �N �-l�96`7C]
Person authm'¢ed Oy EWy execute0 Power ol Attm�ey w Gy IC Gi.7-72-0.7
Attm e
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Data (rt�a�ntb.
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