HomeMy WebLinkAboutMortgage_Emery^y STATEMENT OF MORTGAGE OR CONTRACT INDE
• FOR DEDUCTION FROM ASSESSED VALUATION
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�' � Presm'heE by DeO���rt af L�i GovemmeM Finance
Coun hip
File Mark
STRUCTIONS:
To be filed in person or by ma�l with the CountyAudito� or Counry Recorder of the county where the property is located. F h.
Filirg Dates: 7) Real Property Must fife dunng the }rear for which the deductlon is soughL � ��
2) Mo6Ae / Manufaclured Hortres not assessed es Real Property: Must file during fhe twelve (72) months
6etae March 31 of each year fhe deduclion is sayhG Cou R er
See revers side for additionel instructions arM qualifications. G I
Mpi'cant o ortmtraC buyer- sea re^5r,i�dons on mverse siCe)
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T �Di�s/trirt Key / kgal desai p Remred�numhrs Pag/� number Q
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Nan Nal al appGranl, ud'rcate Celow:
Name of rtnrtgagea or mn seller
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Pddres M mortgagee or contracl se9er (num6er ar
Name ot assignee w other ovmer or hdder of mwt<
Address of ignce 4numberand svee; tlry,/state'.
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Does ePP�mnt awn P DertY in en er
cou�uy in Ind"�ana? ❑ Yes
❑ No
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Deductlan aov�d b tl+e artnunt ot
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If yes. wha[ munty?
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sameane
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equilade ownM
] Yes ❑ No
__—I.�c Me oroPertY rtt Oueslim: MnueAy Assessed
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�R�.o �. °�,,;:;y �1Y101 '- -
Dra�ver i1'0..�� I v� . .�1
Card NO. ....j?.°,�� -
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Wh2t Tad� D"6triU7
Has Utis dedtxtion been re9uestetl m C�RY
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20 _ 20 _ 20 _ 20 _ 20 _ 20 _ 20 _
y�anae of CoimtY AudRar Cau�b Date (morrth. daY• Yea�
1/ We certfy under the penalty M ury that Ne a e and firegoing information is W e and cortea and that Ne applirant is a resident of Ind�ana ard
awner % mntrad buyer of the aforementioned prop on date appfication is filed.
l�r;fPxrrefs7u0neme) Date (rt�mth, daY.Y�e+)
ry `cv-� � �—�
�up resident a0tlress of appfimnt (num6e�arM stree4 a1}; sta�e, arM LP cadeJ
l� 3 SD S, Rt'ooK� u�,l �J�,r�T li /��+ fi S
Pelson authomed by OWy ezecu:e0 Power of Attart�eY «M IC 61.1-12-0.7
De�'� (number arM sbee4 ciN. state. en0 LP mde)
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