HomeMy WebLinkAboutMortgage_Hamer-Poling^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
' srace rom a3�os �ai i i�s)
S i p�b¢d by pepartment of lnd Govemrtrent FnarKe
INSTRUCTIONS: o,fltse yy�
To 6e filed in person w by mad with the CaunryAWitor or Counry Recader o! the counry whe/e the properfy is located. ��. V J( � � Z
Frlitg Dates: 7) Real Pmperty: Must fJe during the year /or whicM1 the deduction is soughG Counry Auditor
2) Mo6i7e / Manufaclured Hanes rrot assessed as Real Praperty: Must Re dunng the M+elve (12) months C.
befo�a Maich 31 of each year the deduclion is snu��ht. - nty Recordef
See reverse side fw eddrtional insfructiions and qualificatbns. G IBSON C
Ap�''��/yy{� x+reroraon4ar16uyu-see�p�Jm�n/ne mreversesCe) /J � I
Y � 1 L _ �}'9� �� . . . / //1 w�. w A � /YCJ /YL�Q
a�.w raNe d reat po�y as a
Me'd� 7, amertl year
I( iw, wfia[ is his / he! exacl share 01 inte.rest?
It name an rcwrd is dMerent Uun
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Mortgage / Cantract IndrbteCr
March 1, tvrtent year
Name of moR8a9ee w conttaG setler
G M A c._ y
Pddres of rt�ortgagce a cmtract seAer (nwnbe� end sOSe; ciry, state. aM LP
Name M assignee or other owner or hdder of mortgaga
AddreSS ai asv nee�number arM stree; tity, 51ate, antl LP pOde)
��w
L K/ (J " :J
Dces appluanc am pmperty in any oNer If yes, wha[ countyt
oounryinlnd"o�u? ❑ Yes ❑ No
pe�ucUpn approved in Ihe amounl af.
20 _ 20 _ 20
Sigre¢rte of Cour:tY Auditor '
I/ We certify under the penaliy of perjury the above a ore
owner / mntract buyer of the aforementioned pmperty o te el
� nue�owne/shAname)
F I rnt dress o a t(n ber antl tily, slate emd LP ca
'� �a � I� � Vl " 1 1
Peison autMfineE Ey duy e<ewced Power of Atmrtiey w by IC G7.1-12-0.7
Address af au4wr'ved per'..on (numbe�arN snee; rity, sfate, eM LP cnde)
cauNrr
RBP]fd IIUIi1bPl
�. s� a-o�-� a�►�-
i as d Mwtgage I Conrut udebtedness unD� as of Lv Ne
date of aPP� �
Q�
Ii ovmed wiM someone othet spouse. ind�cate wlih whom
Is Ihe PmPert1' in QuesGan: Mnu�
�Sie� �ov�+Y ❑ nnr,ua
h�otae
Page numbrl
S�o
Yes U No
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orso-im �V.: � • /. • . .
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Catd�Q���$(�_(Ji7
N
20 _ � 20 _
Counry
20 _ � 20 _
infortnation is true and correct and that the applirant is a resident of Indiana arM
ion is filed.
Date (month, day, yea�
�,�„�. �Y ��
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