HomeMy WebLinkAboutMortgage_Page (4)^'n4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ovmship Year
_ - FOR DEDUCTION FROM ASSESSED VALUATION
� • Sia[e Fwm 43709 (R71 / 609)
�' � Presaibed q' DeP��M af Local Govemment Firw¢e
INSTRUCTIONS:
To be filed in person or by mail with Ne CounryAuditor or Counry Rewrder of the cnunty where the property is located. �� Z0�3
Filirg Dates: 1) Real Properly: Must file during fhe year for which fhe deduc6on is soughL County Auditor !
2) Mo6�ie / Manufactured Hwnes not assessed as Real Property: Mus! file during the hvelve (12J months '
6efore March 37 0/ each year the deduction is sought ^
See reverse sbde for addrtional instniclbns a/M qualifications.
Appfzan�(pwperwcon7aCbuyer-seeresbicLOnsmre 'e)
% 6C _ _ _ _ Tl 1 � J� . _ • r1L �_ �' /7 � n
Ta�drg 0' "d " Key numEer / I al de:
Assessed rdlue of mal pmperty az o Mor�ag�
MarM 1. amellt yPar Mart�h 1, a
II lq. Whdl �S N5 7 Mf BYd[Y 11218 OI YlI¢f¢52?
n rwre a, rcma is d:rwa�t u�ari w� or aaw
wai
Eebw
4dehtedvness u
Name at mortgagee or conbarl seller /�
J
Address of mwt9agce or mntrad seller (numhu and streef, riry, state, and Z
Name ot assignee or athr+owner v hdder of mortgage
nae�ess af asvgnee
Does epplitant own
counry in Indiana?
� �pp�o�d m me ama,m ot
20 _ 20 _
bteEness un0ab as of I �s me ePGmm ma sae
legal or equllaWe mmeYl
❑ Yes ❑ No
5�01158. ��C814 WII�1 VlilOfll
�S I�IC PfOPCfry III QU25i10I1: iV1N�2m/ilSSP5524
� Real PeoPehY ❑!`?m!�a�Y `0.sessed__ _ . " "
It yes. what muntyl —..I What 7a�dlp7 D'¢tricPl Has ihis deduGion
— (Of WfRllt j�P2(�
- f � ��/�/ET7� W�y�c —
- �ua�."Ttl� Kac"
� aWa- � �r3a 20—
sted on O�Y
Yes ❑ No
2� _
u�ature ot Caunry Autlitor .. I �ate (month. daY Ypa�
�
�I I e ceRify under Ne penalty of perjury that the above arW (oregoing infortnation is W e and corteU arid that Ne applipnt is a resident of Indiana aM
iner I contract buyer of lhe afwementioned property on date appfiption is filed. -
!namre (awriers/ \ � . _ bi�- � � , .. _ �' l _ Y7Y–'�� �
FW
dWy eiecuteC Power of Attvney oi by IC G7.1-12-0.7 � . I�(�+�. �Y• Y��_
i person (numDe� arM sbeef, ury; slate, anO LP mda) .