HomeMy WebLinkAboutMortgage_Fulcherk
r
"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
• FOR DEDUCTION FROM ASSESSED VALUATION
:• Sfate Fom 43709IR11 / fi-09)
� � p�esvibed by �epartment af Lo�al Govemment Finarrs
INSTRUCTIONS:
To be h7ed in person or by mail wiM the CowrtyAWitw or Counry Recorder o/ Ne oounty where the properfy is located. ����
Fdirg Dates: 7) Real PropertY. Must file durirg the year for which the deduction is soughL County Audimr
2J Mo6Be / Manufactured Homes rrot assessed as Real Property: Must file dunng the hvelve (12) months
before March 31 of each year the dedudion is sought C� � nty Recorder
See reverse side lor adddtional instructions arM qualificatbns.
M (ox+rerormnvafl6uye�'see mrerrrseside)
7' istrict . Key �wmhel / legal desaiption RewN numher Page numbu
.�� �6 - I sz.n� - 3 03 -000. 38o-v�. �oi � � o
f ralue of real popsty as W
ar�crt year
Y��
I( ra, what is his! her e�ct stiare of intemstl
If r�artie on remtl is ddfemnt Wn Nat ot aPpOranL mdinte 6elmr.
Name ot rtnrtgagee or mntraa sellu
AGdres of mortc,)agce ar mntract seller (nwMer and sveef, '. sta�. aM i
Name of assi9nee or other ew�ar or hdder of rtqngage
AEC2ss at assi9nee (number aiM svee4 Gb, s+efe, a+id LP co0e)
Dces epPli�nt ovm PmCertY in any oNer I( yes. what counp/1
munrymin0mna? ❑ Y25 ❑ No
DeaucEm approved in
20 _ I 20 _ I 20
SigrehirenU CotmH AuSitor
1" �
1 I We certfy uMer the penalry af 'ury that the
owner I contract buyer af ihe afofementioned pro
f as of Mongage I Cortsact intlehtedness unPaid as d LS ihe aDP�nl Ne sole
tlate of app�ateon � w equitable amrYt
I I D ❑ Yes ❑ No
tt awned wi� someone ther tlun spo�ae, Indkate Wth whom
Ls ihe Ompeny m pu�tion: MnueDy Pssessed
❑ Real PmPertY ❑ Mnua��Y ASSessed
. Molvle Fbme (IC 61.1-�
r��.. �,�-- - -�
� �� ��
:�D/� �o�� �
_ 20 _ 20 _ 20 _ 20 _
Counry Date (moNh. daY. Y��1
e arW toregdng infortnation is We and correct arM that the applinnt is a resident of Ind�ana aM
on date appli�alion is filed.
n / 7 trate (rtmm, daY. Y�)
luty exew;ed Power of Apuney w Cy IC 67.
person (num6erand svae4 �: �%e. am12