HomeMy WebLinkAboutMortgage_Napier^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co Yea�
a FOR DEDUCTION FROM ASSESSED VALUATION
� • State Fortn 93709 (R71 /649) EC 2 4 2012
S,� ? p��'p¢d py DepartmeN af Lnml Govemrtrent F� File
�7RUCT70NS:� F�A�,�,� .
To 6e h7ed in person or 6y mail with the CounlyAudito� or Counry Recorder o/ the county where the property is located. A1' p1TOR
Fifim,7 Dates: 1) Real PropeRy: Must file dunng the year (o� which fhe deduction is soughf. �U��nry Auditor
2) Mobile /Manufactured Homes rrof assessed as Real Property: Must f+le during the fwelve (72) months GIB �N � Counry Recorder
be(ore March 31 of each year Me deduclion is sought.
See reverse side /or addittionel inshuct'ans and qual"dications.
f�ah�e of real popttty as ot
acrera year
ro, what Is his / her ezaU sharc ot
narne at �m�d'6 Attferent Nan ih
Name ot
orcontracl
r+ama or asv9�ee a wne� owner o� naai
Aderess of a�9�ee (number ar�d sveet
Dces epplimnc wm property in any oNer
counry in Indana? ❑ Y�
ction apprwad in Vre amwnt of:
20 _ 20 _
.
nber / legal de_saiptio
Mor[qa �/ contrau 4deht
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ont hditate bebw.
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� a�d �ec �ny, �m. e�d �
mortgage
slate, ard LP cade)
If yes. what counp?
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o lJ � l
as of Mwtgage / Con7u3
tlate of app�catun
IF awned wi� someone oiha Nan sprnae�
Record numhrf Pa9g numCP1
Q� � � C
unpaid a of Is Ihe aVPGrant the sda
tegal w equitable wmrll
❑ No
id'icate Mih xfiom
perry in QuesCm: MnuaM Assessed
ProPertY ❑ Hirt�ualhl.Assessed . . .
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Dra\�'Cr \0....
Card NO. ....��`'''`•.....
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20 � 20
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I I We certify under the penatty of perjury that ihe above arW foregoing infortnation is we and correct and that Ne applinnt is a resideni of Indiana aM
owner I mntract buyer of the aforementioned property on date application is filed.
�naaue owne/s NV reme . — 6ate (montA. daY.l'aa�
��,� 1 n 17 /Z� /7c� l 2
rrsident address af appOrant (n 6erarM stree ary, sfata, erd LP mtle)
'�09 �_`��Si' �in�Q�n I ��"(n�0
uson authomed Dy EWy exea�.d Power of AttorneY or by IC 67.1-12-0.7 —r �(�^�h. �Y•Y��
ME� af auCamsd 7F+� (num6er arM sbcet �Y. s1a+e.