HomeMy WebLinkAboutMortgage_Sisk (4)^'�+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ip
_ • FOR DEDUCTION FROM ASSESSED VALUATION
. .. • Sfate Fortn 93709 (R71 / b-09)
�` � � presaibed by Department of Local Gov¢rnm¢nt Frence
File t�c 2 1 Z012
�STRUCTIONS: ��
To 6e filed in erson or b ma�i with the Coun AudiMr or Coun RewNer of the ooun where the ro FOf°' �� �''
P Y �Y N h' P PQnY is bcated.
F�irg Dates: i) Real Property Must file durirg the year /or which tha deduction is sought. un
2) Mo6�7e / Manu/aclurcd Homes lwt assessed as Real Properiy Must fi7e dunng the hveNe (72) rtwnths �� Ty
betore March 31 of each year the deduclion is soughG CountyRe�e��
COUNTr n""�T R
See reverse side (or additional inshuctinns and quali�catkns.
1
ra�o ' mn // _ /�� tl / O � /O� —(/�/� ll � O� a (d numba /. / o �
v �a
As.seneC �ahie af aal popMy as W Mw�ag e/ Contract 4de6tetlness unpaid az of Mwigage / ConYa� trdehtedness unpaid as d Is ihe apP�nt Na sole
Ma�ch i. ament year March 1. arrent yeer date of apP�� � w equitahle oxn�
❑ Yes ❑ No
tl no, what Is his I her e�C share of interest? H ovmed wiN someone oNer tlun spouse, Indicate with whom
If name m remrd is dAfuent t7un Ihat ot aPP��t 6Wifate belavr. Is e WoFe+b in 9uesdm: Mnually f�ssessed
Real ProPenY ❑ %���N `�
ModleHome IC61.7-�
Name a ee a contraa seAer i /
w oWr1 owner or hdder of morigage
Flaares5 or axv9nee lnumcer am suee4 �3: state.
oces epofiCanl own vrovem
caunry in IMana7 r-
20
amount of
�
a}; sbfi. aM LP wde)
LP code)
If yes. what munryR
�o��
20 I 20
��T�� o��� � s 11, m� Er a�-
20 _
l�— (�y 83
Date (rna�rth. day,
I/ We ceNfy under the penaliy of perjury that the above aM foregoing infortnation is We and wrtect and that the appiinnt is a resideni of Indiana aM
owner I contracl buyer of the aforementioned properry on date application is filed.
�retue (ovmefs hN ^4,^ie) .� � Date (monM, daY. Y��
Paswi auNaaeO by tlWy ezew:ed
state, er
, _
M
pr�son (numDerantl sveet ah, sblk en0 LPCOde)
67 0
tlay, yea�