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^'� STATEMENT OF MORTGAGE OR CONTRAC if�NE� oun Township vear
: FOR DEDUCTION FROM ASSESSED VALUA �/
' sm�a w�,�, a3�oe �n i s ae�
�' � i p���bed M�P�nt ot LoW Gwemment Firwice
,� pEC 14 2� File Mark
wsrnucnoNS:
To be Aed in person or 6y mad with the CowtyAudiror or Counry Recorder o/ the county whQgt .Ai� Fn�� Fam (ued wRh:
Fdirg Dates: 1) Real Property: Must file durirg Me yrear (or which the deduction is sought. �p\SdR � �unry Audimr
2) Mo6Re /Manulactured Homes rrot assessed as Real Property: Must fiie dwing fhe l���mon(hs
6efore March 31 of each year the deduction is sought. G\g5�pl C ❑ Counry Recorder
See reverse side for additional instructnons and qualifrcafions.
MP�+� Prmntrdvbuye'seeresMC0o2sm re snie) •
7' istria K y ntmCer / iegal desaiDl'mn RemrO num0er Page numbrl
' � � � O Q 7
vahle of real pfopnty az M Mortga9e/ Contract 4dehtedness unpaid as of Mortgape / Con� irde6teAne55 unPaiO as o( Is Ihe ePP�I Ne sole
Ma�ch 1. aarerQ year March 1. arten[ yeer date of ePPO�tnn legal w equitahle amerl
❑ Yes ❑ No
Ii ro, what Is his / her e�rl shart ot intere5i? tt owned wi� mmeone Wh+v tlwi spo�sa, 4dkate WIU� Whom
If name on remrd is difte�ent Nan that ot aOP��t IMkate Oebw: Is the praperty in question: MnuaM AzsrsseE
ProPenY ❑MmuallyF�55e55ed
MoWle Home C 61.1-7)
Name of martgagee or mntraa seller n �
//
/
Address of mort9agee w mntraC seUer (numbe� and svae4 �Y. ��e. eM ZIP code)
Nameofassigneewaherownerorhdderofmwtga9e - Y.—___""" -'"--' �—
AEC2ss of as9gnee (numbu and stree4 �N: s+ate, aM Z/P code) J' �
..a�.� �....
Dces ePDlipnt rnvn pmperty in any oNer If yes, wha[ munryR W�at Tavrg �isl ll j� al��� C l. \ O•• • ry �'.
munryinlMiaru? ❑ Yes �.
❑ No �� �i � No
' .......�......... _
COUNTYAUDROR C'11-� \O•` t� C�1 _ u.�
Drauction approved 4i tlre amount of: 5\`C ���'
20 _ 20 _ 2q _ 20 20 _ 20 _ 20 _
Signaarte ot Co�mN Aueitw Counry Date (monN. daY• Yea�
I I We certify under the penalry of perjury that Ne above and foregoing infortnalion is we and correU and that the applirant is a resident of Indiana and
owner % wntract buyer of the aforementioned properry on date application is fileC.
SlgreNre (owne/s hdl mme) � Date (rtrmtlt. daY• Yma+)
�
W �esident aEd`es of appGCant (number a sbeet, dty, state, entl LP oode)
0 '�. � 4 7p �
Persnn autlro�¢ed by duly �eated Pawer of Atmrney or Cy IC 67. -12-0.7 Date (monfi. daY. Y�+I
Addtess of authoi¢Ed person (numberantl sfreeC u�i: sbte, aMLPCOtle) ,