HomeMy WebLinkAboutMortgage_Heldt^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year �
• FOR DEDUCTION FROM ASSESSED VALUATION
— . sr�e rbrm a3�oe �rt„ i s-oe) � � � �
,' ,,,, � P2safEed M DeP��rn af Lod Govenunem Fuance
File Mark
wsrRUCnoNS:
To be filed in erson or b mail wifh the Coun Auditor or Coun Recorder o/ fhe coun � Fwm mea with:
P Y h' tY N y��@ � P�o�is located.
Filing Dates: 1) Real Property: Must file dun� the year for which Iha deduction is sougM'" ' ���h, q���
2) Mo6Be / Manu(aclured Homes irot assessed as Real P�nperfy: Must file duripg the (12) months
6efae March 31 01 each year the deduction is myhG C.:l. ❑ County Recorder
See reversa side for ad '" nal lnsWCGons end qualifications.
nppfrant(ox+ierar 6uyef-see nsm sife)
T ' tri /� Key Oe / �90aC P N -� �— r�V /' / / /—� / Record n Ober� Page,rry, .� /
J I �-; �;
Ma�d� 1, tarrent year as N �� je �� �av�d-.eb /�OO of �� app0 fation iMehtedness unPaid as d Is�Ne�p❑p� ��e O
i/
rc no, what Is nis I her e�oe share or inrr�esn rc ownea wim someone ahrl u,an saouse. inaicaee wim whom
Ii nartre on �ecad s mife�ent Nan ihat of epp6canf, uNkate belrnr. Is N�e P�GeNY � Vuestian: MnuaDy Assessed
❑ Rea� a(operty ❑ Mm,a�y w5sessed
Modle Hane C 61.1-
Name ot mortgagea or mntrarl seller �j
J
Addres of rtiortga9ee or rmtrarl seAer (mrnbri erd stree; cdy; state, anp LP code)
Name af assi�ee or othu owner or holdu at �mtgage
AAtlress of assigtree (numbarad sLeet rin..-�---- . —��—
Dors epplinnt ovm O�F - " 0 I • • • ��. • • . . •
taunry in IrW'ena? D 1� il\�� CI � O•••••••• .. Tariig D'atrictl Has Nis deEUGion Deen requested on 7�P�Y
' 1, , -. for turrent Y�R � Yes ❑ No
, I 1 V� ; ..
C�t'v \0 . .........n..... ..� -art
De�ucGOnaPW�d�� �� 1� (JW• �
20 _ _ 20 _ 20 _ 20 _ 20 _ 20 _
Sign f .ry Caunry Date (rt»nth. Y, yxar)._, ��
/ y
I/ We certify under Ne penatty o pe Nat Ne above a d( egoing infortnatlon is W e end correU and that Ne appli�ant is a resident of Indw�a arid
owner I contract buyer of the aforementioned property an da application is filed.
SIB�nire_ wnc/s fu0 Date (monfi, day, yea�
\_� _ 4 _
WI ent eOCres d ppGrant (num � and ' state, arid LP code)
l'7 t 5 7(o7b
Pr�.m auttwraed by EWy esecvied Pwer of w by IC G7.7-12-0.7 Date (montl�. Cay, yea�
Address of aufhor'vEd person (numberentl sboe; Uty, sbta, antl LP mde) .