HomeMy WebLinkAboutMortgage_Whitaker"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7 sh ar �
__ • FOR DEDUCTION FROM ASSESSED VALUATION
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•�' "- 1 Presmbed M OePartmeN af Lacal GwemmeM Fifarcx
wsrnucnoNS:
D��S �� 2012
To 6e fiied in person a by mai7 with the CourrtyAUditor or Counry Recorder of the counry where fhe piopeAy is located. �J.
Filirg Dates: 1 J Real Property: Must fi!e durirg fhe year fi� which the deductlon is sought. � �y ���
2) Mo6de / Manufactured Homes not assessed as Real Property: Must file dunng the tvrelve (72) months �1
beforeMa�ch3fofeachyearMedeductionissoughG ('ilB ONL:1➢UI�PYny4i�1��
See reversa side /or additional instructions and qualifieQtions.
mrevers9�0) / +
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tt ro, what's his I her e�1 share of interesi?
It name on remN's CMem�t Nan that ot aOPGCant. uWk
nr�
Name of mortgagee or mntrarl seller
Addres M rt�gee a oontrad se0er (n er ard
Name oi assi�ee ar other owner or hdder of mortgage
AdCress ot asv�ee (numberand s(ree4 dry, state. antl
Dces epP��aN own prtapbly in arry oMer
counry in Ind'are?
❑ .Yes ❑ No
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�U�-o�v� -��o
a d Marigage / ContraC "a�de,6tei
date ot aaP�� / J s-
If ovmed vriN someone
RecoN numbel P wmb�j
O /.? %
ss unPaid as of LS ihe aPPGmnI Na sok
Iegal or equita6le oMnM
❑ Yes ❑ No
s, Indimle with wiwm
properry in Question: Annually Assessed
eaIPrOPeNY Q!�?m�allyAsse�...
-a-9 i � �a�
1T Has Nis tledufYian been 2qursted an P�De+iY
far curtent Y�n ❑ Yes ❑ I
' COUNTYAUDROR
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.a...... zo_ 20_ Zo_ zo_
Drawer NO...... O�
` . /� I� Caunry Date (rrWh. daY, Yea�
I n
Card NO. .... `� :.............
] foregoing infortnatlon is W e and cortec[ arM �hat the applipnt is a resident of indqna aM
c0t1 UyC�rnu�eetuc��ic.� �.,� ,� ..,alCapplirdtlOf115fi12d.
�) � ii , A . Date (monfi. daY.1'��
state,
Person autlw�rseE by duy e�cewted F'rnwer of Ammey or by IC GY.1`72-0.7 - �� � - I Date (rtqnN, tlaY• Y��
puwn (num0er and sbcef, fi(y, sbte, sM ZIP oode)