HomeMy WebLinkAboutMortgage_Hyneman (5)^'�a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship vear
_ • FOR DEDUCTION FROM ASSESSED VALUATION
� ' smee Fw,n aa�os (an i s-�>
S,.� T�,�����e,�,���F� � I L� I�
File Mark
wsrnucnoNS:
To be fi(ed in rson or b mail wifh the Coun Auditor or Coun Recorder o� the coun where the ro Farm med with:
ae Y N b iv v PertY is located.
Fili�g Dates: 1) Real Property: Must file during the year (or which tha deduclion is so �ty q���
2) Mo6ile / Manufadured Homes not assessed es Real P/opeRy�r�t I��r�kFe M1vefve (72) mwths County Remrder
befae March 31 oJ each year the deductnon is soughG -
See reverse side far additional instrucUons a�d qualifi ions. C���
Mpfcam(owneror b -see mre seie)
_ . IA.���Y._. ,� ,I�l (1 /L211'qSDI�'RPUy7Y AUDITOR
��are�wcaPnrasa Mo
Mard� 1. axrP�li yPat M2
rc ro, what Is his / her e� shara ot interest?
If nartre on recad is dMeirnt ihan Nat ol aPP�L m
Name of mortgagce or wntrarl se0er
pddreR pf mortgagce or contraU se0er (numbe� ard
Name at assi9nee w Uher mmer w haldu of mortga
Atltlress of assignee (numberarM stree; ary, stefi, a
property in eny ONu
❑ Yes
cUOn approued'c� the artrount oE
20 _ 20 _
:R7
20
-ao3-oc�.�3�o-oa� �'�,�"��la
indehtedness unpaid as of Mwigage / CantraY trWehtednr.s �mGaid as d Is �he
�n �� � date af aPP���� �9�
and
I I We certify under the penalry ot perjury tF�t Me above and fc
owner I mntrad buyer of the atorementioned property on date
0
auNOr¢ed prJSOn (numDer arM sbaeG �'iry, stata, end ZIP code)
It ovmeC wi� someona aMer lltan spouse, iMitate wlth wham
VJh
�-/
titaNe ovmeYl
Yes ❑ No
b the pmpeny in Guestian: MnuaM hssessed
� Real P(oPenY � ?!?�!��h;�
been re9ueste0 m 7�W�Y
.Dl':IlyCl' f�'�..t�7�J�� .....
COUNTY A
c��-� 1�.0. ......J�.9y
20_ .. .. /....
���, � � 5a 3y c�
A�Ci 6.r,�,._ � lr.
20
infortnation is W e and comect ar�d ihat the applirant is a resitlen[ of Indiana and
ion is filed.
Date (monlh, daY• Yaa�)
�
aar. rBeA