HomeMy WebLinkAboutMortgage_Bennington^'� STATEMENT OF MORTGAGE OR CONTRA N�E�E I�Si6 Coun
.�_ s FOR DEDUCTION FROM ASSESSED VALU TIOJ� .
' S�� �� ��� cR,,, �> pE� 1 � 2012
�+ w� i p��bed by Department af L�1 Govemrtrent Franca
INSTRUCTIONS: C �,,rv\!35�h�k Uu�"
To 6e filed in persan w by mad with the CowryAUditor or Counry Recorder of the cnunry where the p ed.
FAmg Dates: 1) Real Property Must file dunrg the year fir which tha deducfion is soughG r.1TY p
2J MobAe /Manufacfured Homes rrot assessed as Real P/operty: My��V�iA N+elve (f 2) rtqnths
before March 31 oI each year the deductnon is soughG �3
See �everse side /or additional instnxtions and qualificalions.
Appficant (owner conMart buyer- see reSNtbons m reverse sid'ry� '
�an„-, �0,�„ / q'-i 5��m.�lnn 1� mmim„%)
n�ea vaam or mai �eny � m
M11aiN 7, aarent year
If m. whal Is his ! her exaG share of interest?
If name on record'S QAferent Nan Nat a/ appl
—/✓�� 7L
tgage / Cantra¢ 4
rh 1, curtent yesr
Name at mortgagee w �paa�er \
N J
AEdres of mort9agee w contraa se�ler (numbe and sfree4 �y: sta�. aM LP wde)
Name o1 assignee w otlre! awner ot hdder of rtprtgage
naaRSS o� atvgnee �numoer arw sveeL ury, s�ie, am ur cme)
Dces ePpticant wm propeM1y in any olhu It yes, wN
caunry m Inda�a? r—i .. r-i ..
COUNTY
approved 4� the amount of.
File Mark
Farm HeO wNh:
� CounryAWitnr
❑ County Reoorder
Recofd numbu Page numbu
O � o a �09�
as of Mortgage I Conrae udebtedness unpaitl as d Is the epp�nt the mte
date of aPPfietnn �gal or equita6le o.meYt
❑ Yes ❑ No
� ovmed wi� someone oMer p�an spouse, hdi�ate with wham
Is Ihe pmperty in quesCOn: Mnualty Pssessed
❑ Real Proaem ❑ amua�y assessea
Modle Fbme QC 61.1-i
T:
ao� a
Dra�vcr NO ................... I
Card i�0• .. ���.(....... _
� 1��; 35`�'�
20 _ 20 _ 20 _ 20 _ 20 _ 20 _
roWre d CamH Audrtor Cou�b Date (month, daY. YEa�
I I We certify under the penalry ot perjury that the above and foregoing infortnation is W e and corzect and ihat the applirant is a resident of indiana am1
owner I wntract buyer ot the aforementioned property on date application is 51ed.
uatwe (avme(s NO name) _ �� Date (montA, daY. Yge�
dent addr�s W appOCant (nJmbe7 and s6ee4 �Y te. arM ZIP m
7�' Ol� � /�.s—S fF t� �
auUqt"¢ed Cy dWy ezewtetl Power o(Attomey or by IC 61.7-72-0.7
� of auNw'vN person (numbe� and sbeet, ciry; sfate, en0 LP cade)
o� ��,m. aar. r��
t1