Mortgage_Durham^'�o STATEMENT OF MORTGAGE OR C �NL] E+�S Coun Township Year
.�� _ ; FOR DEDUCTION FROM ASSESSE�L�7f@PV
S� ���� c�„ ��> 2 � 2p\2
�` ,w � p�escip¢d �y �eparimenl of Lacal GovemmeM Fnance
��C File Mark
INS7RUCTfONS: �^ , F� �� ��:
To 6e filed in person a by mad with the CountyAWitor or Counry Recorder o/ Ute county wh the is located.
Fitirg Dates: 7) Real Pmperty: Must fi!e during the year for which the deduclion is sought S�( P � Counry Audimr
2) Mo6de / Manufactured Hanes rrot assessed as Real Ploperty (q0�ing the tweNe (12J months
6efo�e March 31 of each year the deduction is soughG G�$S� Counry Recorder
See reverse side 7ar additional inshuctions and qualfipCpns.
MP�� (owner m mur2Ctyvyer' see lesvicDOns m reverf°ISde) � �
AssesSed vdhre of real pdpMy as of
A1atd1 1, aumltl yPat
Ii m, what Is his I Mr e�G stwe ot interest?
Mortgage/
MarM 1, a
It name m rewrd is 6Remnt Nan Nat o( aDP�. indrca0e DeWw
Name
rtp�t�jagee w mntracl seUer (num8u
c1 assignee or othrl wmer w hdder of mortgage
Atld`ass of assigrree (number antl s1ree4 �1: state, end LP code)
Ooes ePPlipnt own property in any
counry in Ind'ana? r-i ..
c6on approved'ui tl�e amwnt oF.
20 20
Auditor
% / ' /
as of Morigage I Convacl'vitlebtedness �mpaid as of
date of appOCatirn
❑ Yes ❑ No
It awned wi� someone oMrs tlun spoise. 4dkate Wrth whom
cade)
couNn auoROa
20 20
Counry
is C�e ProOe+b in Questia� MnuaoyAssesed
❑ Real Property Q Armualy Pssessed
��
�u,e I-�9�� �,,�y �
/ �1-1 jss�
-�
�a[e i�m. w., . - .
I/ We certiry uMer Ne penalry of perjury Nat ihe above a�W foregoing infortnatlon is true and cortea aritl that the applirant is a resident ot Indiana arM
owner I contraa buyer of Ne aforementioned properry on date ap�cation is filed.
)fu�lreJGUmCLs Mllmme) ,/ - . Date (rtionth. daY. Yea+)
ss W ac6Gtant (num6er antl sbec4 �1: �te, eM LP cod��
t�:J�-(OVSC�w��sutlle ��
ny ewr e.ew�a aowP, otum�,ey or ny ic s-+.i-�z-0.�
coae)
� CR
�r. r�d