HomeMy WebLinkAboutMortgage_Rich°'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
:.--
• FOR DEDUCTION FROM ASSESSED VALUATION
5tate Fan„ 43,09 (R„ , 609> � I L
�` � Presrn'Eed M DePertmeM of Lnfal GavemmeM Fnance
File Mark
INSTRUCTIONS: Form Aed wiN:
To 6e filed in person or by mad witA the CowryAuditor or County Recorder o/ fhe county wh�ie pro{�er��ocated.
Fiflng Dates: 1) Real Property: Must hte durirg the year /or which the deductlon is soughL � Counry Audimr
2J MobBe / ManNactured Homes rrot assessed es Real Property. Must fife dun2g Ne��i�� " Vnths
before Ma�ch 31 of each year the deduUion is sought. �� ❑ County Recorder
See reverse side lor addilional instrucUons arW qualificatbns. ,__ �
ed ralue of r�
1. ament year
I10. �4'h3I i5 h15 i IIEI ¢]0U ..�WB Oi Il1}Cf¢51?
� LCJ -GVV � "t / �^V
Mor�qa9e I ContraG Udehtetlness unpaid as ot Mwigage / ContraG'uWebtedness unpaid as of
March 1. curtenilrar _ ..-. tlate o( aGPG<atian
If nartie m rerurd is 6lfermt Uun Nat of appfirartl, cmdwrte Eebw:
Name o(
mntraG seller (number aM stree4 �'. �e. aM Z/P code)
Name ot assignea or omv owner or naaer m mortgage
AdCress of atagnee (numOei arM street �+h. s+zte, antl LP cade)
Does applinnt vam propeM1y in any oNer If yes, wh�
counryinlndaia? ❑ Yes ❑ No
De�ucOon approved in ttre amaunt of:
20 _ 20 _ 20 _
tt awnad wi� somearie oNer Nan spouse� trWimte witl� wtwm
COUNTYAUDROR
Page num0ef
❑ Yes
No
W�D�Y YI Q�IPSIYlI1: HfIf1U8M ASSCSSCd
e� �openr 0 ^r�,�Nw�
�,b61e Home (IC 61.
�/8a��y��w
Drativer NO.... °.2.�1�,.., —
Card 1\`O. ..... .
ainSS p�
...... � ,
20 � 20 _
County
20 _ I 20
Date (rno�rth.
I I We cerufy urWer the penalry of perjury that the above antl foregoing iniortnation is We and cortect a+�d that the applipnt is a resident of IrMiana aM
owner I contracl buyer of the a�premenJ�ned pfoperty on date application is filed.
1reWre Data (rmiU�. daY. 3'8�7
(number ariC sLee4 dty, state,
authoraed Oy CNy esewteE Power o(Atta*�eY « M IC 61.1-12-0.7
CP+sm
�pnfi. tlaY• Y�A