HomeMy WebLinkAboutMortgage_Wirth^'� STATEMENT OF MORTGAGE OR CONTRAC�7ND�_E��I�E Coun Township Year
__ • FOR DEDUCTION FROM ASSESSED VALUATiOft
• Sfa[e Fwm <3709 (R71 / b-09)
�,,,, f P,�,���,���,�����F� FEB 11 2013
File Mark
INSTRUCTIONS: F� �� ��:
To be fi(ed in person or by mad with the CourttyAWito� or Counry Recorder o! the� erty is located.
Filirg Dates: 1) Real PmpeRy: Must file dudng the yea� for which tha ded�?yqq Q{y '�IuTV���nT � Counry Auditor
2) Mob�7e / Manufactured Homes irot assessed as Real Prtipe7tj�"ID t h1A' m�g me 1vn.� f 7� r%�onths
6elore March 31 of each year fhe deduction is soughG ❑ Caunry Remrdu
See reverse side /or addilional instn�cGons end qua/fications.
Appf t(owner confrdCbuyrr-see mreversesile)
T' �istriU Key �umhel/ Iegal desaiption Recortl num6er Page numbnr
-I - SS'. - OD � �.10 -��
� raqm d real popttty Mortgag� / Contraa indehtednrss unpaN az of hbrtgage / Contrac[ WebteM¢ss unpaid as d Is the apPGont �he sde
MaM 1. amenll� Marti� 1, aurent Y� date of aPP�� k9al w eWitaWe amerl
i' �I ❑Yes ❑�No
n na w7,at is ha / her e�ae dwe or interesn rc wmea wi� san,eofre othei man spaae. h,aicate wlm whom
tt name m remrd's 6Rerent Nan Ihat of app6rent uWita� bebvr. Is C�e OroPP+�Y in pursfion: MnualtyPssessed
eal PfopeAy ❑ NmUaIlyA55eS5ed
M1bWleHOme ICGt.t-�
Name of mort8a9ee w UaU seller
U S�. -
Addtess of mortga9ee w bacl uDer (nwn6er aM stree; ciry, sb1e, aM code) -"
Name af asvgnee v oMrl owner or halder af rtprtgage �jU'— `j``%tU �+ � � L pRrR
Address ot assgnea (number ar�d stree; tlly, stafe. arq LP code) ," �U "�_ 1 5� �
F/
Oars applinnt own yoperty in an olher If (
Y �.,��m�,� ,��T�, T �� �33 „�
counryinlnEwu? ❑ Yes ❑ No �� �Q�.�� lo�� _ L7 No �
OUNTY AUOROR I �, � �
Detluction approvad'c� the artrount of.
20 _ 20 _ 20 20 20 _ 20 _ 20 _
Sigfuhrte of CoimbAWitor Counb Date (monlh. daY. YEa�
I/ We certify under the penalry of perjury that the above arW foregoing infortnation is We and mrte�2 and Nat the applirant is a resident of Ind�ana afxl
owner I mn4acl buyer oi the aforementioned property on date application is filed.
reyre efs !u� me) `'�� ) Date (mmfi, daY. Ym�)
� "l/' .
�A 2vdQnt of app�qnt (number an7 stree4 �1; �te. ar�R LP cade)
Y w� a- oQ. /�. � c,
auUnt'¢cd Dy OWy execv�d Paxcr af Atmrtmy w by IC 61.1-12-0.7 �e (monfh. daY. Y�
AOdrrss of authw'¢ed pei'..on (numDer arM sbae; dy, sble, eM LP oode) .