HomeMy WebLinkAboutMortgage_Lamey (13)^'no STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ovmship Year
__ • FOR DEDUCTION FROM ASSESSED VALUATION
. s�e ro�„ as�os (R„ i s-as)
t' ,,,, % rresmtea M oea�rn af Lod F,wemmenc Firer�c
File Mark
INSTRUCTIONS:
To be filed in rson or b mad wdh the Coun AWitor orCoun Recorder of Ne coun where the ro Fortn Aed wi�h:
Pe Y �Y N 4' P certY is rocared.
Fi1i�g Dates: 1) Real Pmperty: Must fite during the year lor which the deducfion is soughG � Counry Avditor
2J Mobde /Manufedured Homes not assessed as Real Property Must fJe dunng the hveJve months
before Ma/ch 37 of each year the deduGion is sought. ��� r� ❑ County RecoNer
Sea reverse side (or additiunal instnrctions arW qualifiptions. ��{
A �R
MP��t(ownerwcontr�y_rer'seore�sonrererseside) .. _ —/� . '
�Y �
It ro. what b his I her euct shara ot int
If narne m remd'6 6.Remnt than Ihat �
Nart�e ot mwtga9ee a
s Of mort9agce or contrad se�el
of assignea w other ownu or hd
s of asa�nce (numberarM stree
3pplicanc oan P�PenY in any othE
ui tlre artmunt o`
l�it {' {' l v A
1
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V'�"v ��
a���
3��-�
20 20
irenrte d CwmN Autlitnr �� �
✓
I I We cerbfy under ihe penatty of fy / ) I���' �n l
owner I mntrad buyer of the afot '�� �� � �� � �
�� �m,�„��am� —
l.l� �-Y
as
unpaid as d
Yes LI No
e oNer than sPOUSe. Intlicate wiN wtwm
Is the Praperty in quesean: MnuaM Assessed
� Real Rope(ty � ArmuallyAssessed
Modle Fbme OC 6
Has Nis Oetluctirn been requested m propGty
forcurtentyeaR � __ �
20 _ � 20 _
:ect arW lhat Me applipnt is a resident of IMiana aM
F�W rPSident adOrass oTappfimnt (numd
i
Pr�son autharsed Ey Cifi' ezecute0 Pow
Address of authoraed person (numbe�s
Dafe (monfh. deY.