HomeMy WebLinkAboutMortgage_Collins�"n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year 1
� FOR DEDUCTION FROM ASSESSED VALUATION
.• Sfate Farm 43709 (R11 / 6-09)
S i p��,'ped q oepartrriern ot �oo� corerrvrront Fnance File Mark
INS7RUCTIONS: �,I m
To be filed in person a by mad witA the CounlyAuditor or Counry Recader of the county where the property is bcated. 1Vo
Flfiry Dates: i) Real Property. Must fite durirg Ne year for which the deduction is sought �,� mry Aud'rtw
2) Mobde / Manufactured Homes irot assessed as Real Pmperty: Mus! file dunng the fweNe (12) months C� C Recorder
6efore March 31 of each year the deduction is sovght.
See �everse side lo, addrtional inshuctbns arrd qualifications. GI BSON C
Aoofrant (owner wcontrdrt 6uyerir sea re5Lirinns m reverse side) , /Y ,
Distrirl
�
tt no, what Is his ! Mr eract shara ol intemstl
tt name m remtl is A�fermt Uan Nat of app[
�-�I(pdag -69-
March i eartlen[ year
�elovr
= 000. -aJ�7 ).t)l �-
npa10 as of MMgage 1 ContralY irWe6tedness unpaid as d �s �he
date of appOration � �
�8 OOZ�
H owned vriN sameona othv ll n spo�e. Indicate wiih wham
Is the P�PenY m quesUOn: Mr
eal Ropertv Q Mm
Name of �nrt9a9ea w contract sepoF � �� L�
}�
qddress a} �Mgage¢ w contract seller (numbe� end sbae; cdy, s�em, aM Z!P code)
Nam¢ of assi9nee a ahrJ owner or holder of mort9age
!W ot asvgnee (number aM street dry, s1aEe, a�d LP wde)
�'f Nw SF_ , �,-�0 3. 78 ,4
Does epPlimnt mxn pmperty in eny other If yes. what munt�7 What
counry in Ind'ana? n Yes ❑ No
I�^R:: �r.'
oi
zo _ I Zo I
�taMe ot Counry Auditor —
T r���
I/ We certify under the penatty(rn perjury
owner I wntracl bWer of the aforemerrtic
Full
AUDROR
20_ zo_
Counry
e above and foregoing mfortnation i!
)rooertv on date aPPfication is filed.
✓IY
, sbte,
M
AdErrss ot auNa'ved 7e�`� (number arM sbee4 �: s!ale.
osma't tf� tho
r� lor aure
�
Page number
5�l[`1
r� u r,o
requesteE on P�P�nY
n Vn_c n No
Dra�vcr i\'O...a � � �
ca������o �y/�........
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oate Imoruh� day, yeaA
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