HomeMy WebLinkAboutMortgage_Umpleby^'3 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
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• FOR DEDUCTION FROM ASSESSED VALUATION
' smca ��m aa�os (an i s-0s�
�' � i p��bed M DeP��ent m Lod Govemment Firance
INSTRUCTIONS:
To be filed in person or 6y mail with the CounlyAuditor or County Recorder of the county where the pmperty is located.
F�7irg Dates: 1) Real Property: Must file dunrg the year Por which the deduction is soughf.
2) Mobile / Manufactured Homes not assessed as Real Pmperty: Must file dunng the tweNe (f 2J monfhs
before March 31 of each year the deduction is sought.
See �everse side lor add'tional instrucUons end qualdications.
I AP ownej.lv m^tr�tt Auyer's�eiesUrlaruA^ re sede) /� .
As�ed �2M1ie oF Ral paprny as ol Mw�qage / Contrac[ N
M2mh 1. nrre�tl year Mamh 1, Nrrenl year
rc ro� wfiat Is his! her euU shara ol interestl
If name on �emd is difterenllhan Nat ol aPP�L bL�m1e Debw:
Name af moRga9ee « mntraC se�lu /'��7 ( J �I,
Address of mortga9ce ar mntraG seller (number aM sveet, cdy, sfam, and i
Name oi assignea w dhu owner or hdder at mwigaga 1
/ / /l
Addass ot assignee (num6er eM af+ae4 Gry �e. entl LP cade)
Does eppiinnt awn pmperty in arry oMer It yes, wha[ munty?
munry in IMgria? ❑ Y�
❑ No
Fortn
�ury(Auditor
�'.ounry Recorder
'(/v. i /(o—[i�/! / viv� v i.��=
1 az of Mortgage / Con'vact unpaid as d Is Ne appGmnt the sde
tlate o( aPP��� legal or equitabie Uvne(1
� (�� ❑ Yes ❑ No
rc awned wi� somea�e oUre1 ihan s . maKate with xiron,
Is praperry in Question: MnuaM AsSesM
Real PfoPe�Y � ?^^!��'1.� . - '
- /- /U ..�� lo�
requesied an D�P�Y
❑ Yes ❑ i
U :�� Ai� �3y ,ioH,� +��z
20 20 20 20 _
�J�.�1 � a J Counry oate (r+rmtft daY. Yea�
:J\ V V �
and foregoing infortnalion is W e end corteG and that the applirant is a resideni of Indiana and
n date appfi[ation is filed.
"_...."""_"'__ _ Dale (rmnth. daY.Y�+�
F ident address of appOqht �numf�� e1tl sheet, M}; state, ern
%, 2c,5s N. a'„ l� n�l x
P�:m author"¢etl trj dWy ezewteE Power af Att�rtiey ar by IC G7.
Pdtlress of auNorrzed persm (numberarM sbee; ciry, state, en0 2
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