HomeMy WebLinkAboutMortgage_Haywood^�3 STATEMENT OF MORTGAGE OR C �l ND���S Coun Township Year
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� FOR DEDUCTION FROM ASSESSED L '6f6N
S ?• 5�a�����,,,�, 11p\1
,,,, Presrn'bed q' DeD��nt of Local Gorertunent Frurce 1
��C 2 File Mark
INSTRUCTIONS:
To 6e fiied in person w by mad wrfh fhe CowrlyAUdifor or Counry Reco�der of ��unry wh th is lxated.
Fdrng Dates: i) Real Property: Must file dunng the year fo� which tha deduction is sought. tY P
2) Mo6�7e / ManuFactured Homes rrot assessed as Real Property: M�t�thS��ng fhe hvelve (72) months
6efae March 31 of each year the deduction is soughG G�g50
See reverse side for addiG'onel instructions arM qualil+cafions.
I APpG�m ( i er wmntraG 6 - see restriffiolss re ife)
�
I Tmu�g District Key num6er / le esaiptl
Q ��
'�,��d�„��� y��,�,�������d�
Ma'di 1. amrnl yPaf 7. airtent ye�r
,�''i / DOIi
Addres of rtnrtqagce ar mntrad
Name
AdCress
limnt own proprlry in any oNer
���� ❑ Yes
pe��cGOn apprtmM In Ne amwnt
a7P��4 hidkate below.
J�-/
awnMl end stree4 �Y. ��. aM 2
�r of mortgage
dry, state, and LP code)
If yes, what muntyl
❑ No
20 _ � 20 _ � 20
d Cau:b nuditar
20 _
Form �Ned wIith:
�Counry Audimr
County Recorder
/ Recoid num0er Pa9e num6el �„
ao ��a�
7e / Convart'ubebtedness unP� as of Is ihe aGPGOnt the sole
aPPO�atbn legal w equitabie owirefl
❑ Yes ❑ No
If awned wI� sameane atlwl Man spaae. 4idipte wiTh rRnm
Pen1' m questim: Mm�aOyASSessed
Pfoperty ❑AmivallyPssessed
Mo6Be Fbme fIC 61.1
_µ��o' i�A�y p
R`` ��`�
� � ~ s ❑ No
�a-��aa
10_ � 20_
daY. Yea�)
I I We certHy uMer the penatry of perjury that the above arW foregoing infortnation is W e and cortect arM ihat the applinnt is a resident of Indiana and
owner I contrad buyer of the afwementioned property on date appiication is 51ed.
Person
tlry, sbte, eid
perem (numDerarN sbeeL �: slate, eM LP code)
Qate (monN. OaY.