HomeMy WebLinkAboutMortgage_Kirby (2)""+ STATEMENT OP MORTGAGE OR CONTRACT INDEBTEDNESS Coun
� FOR DEDUCTION FROM ASSESSED VALUATION
� � StateFarm43709(R77I6O9)
�' ,,,, � Presv�2etl hY DeP�rant oi Lnml GovemmeM Fuwxx
INSTRUCTIONS: .
To 6e filed in person w by ma1 with the CounryAWi[w or Counry Recorder o/ the county where the property is located.
Fitir�g Dates: 1) Real PmpeRy: Must file dunrg fhe year (or whlch the deduciion is sought.
2J MobRe /Manu(aclured Homes irot assessed as Real Properfy Mus! file dunng the fweNe (12) monNs
6efore March 31 of each year the deduction is mught.
Sea reverse side !or adUitional inst/ucUons and qualfications.
�,�o..,�,�`°`�°u t'� :�°�"��,�,�,�'� _' n_ . . ci
� CXro'11-
Asuaed vaNe d real prapeny as N I�lgage / Cont
Marti� 7. ncmtl year d� 7 quient
�
n �o. �c �� � ne� �e snare or ���n
If name on rem�d'S Qlftdent th3n �hat ot aPP��1 bdi�ale below.
Name of moRBa9ee or mntract sdler �� 1
J
Address of mortga9ee w mntracl seller (number aiM sL
Name at assignee w othu owner ar hdder of mortgaga
�
az
tt owned wiN someone
� (numberaM shee4 N�l:.s�- nm �ra...w.�. .
WuDen1'inanyoNer �a..1o����.�
❑ Ye5 [ 1
� 1�.....
�1':l\1'CI' �� .............
u� Iha artrount oF. �
C.11'C� \�. ...��.....i ....�
20 i ' �u
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Year
. f�B q°�5�9�9�°�
U County Remrder
AUDITOR
�itahle ovmell
Yes ❑ No
Is the property in question: Mnualy AssessN
� Real ProPeKY ❑ ��hl �
x7 Has Nis deduCion Eeen
kr wrrent yea(?
20
f•&.v�7
20 _
I�Me of Counb AuEitcr I Counb I Date (rtnNh. daY, Yee�
I/ We cerUfy under the penalry of perjury that the above and toregoing infortnation is We and cortect and that the appiipnt is a resident of Indiana aM
owner I contraa buyer of the aforemerrtioned p(operty on date application is filed. � ' "
F�dl r�idenfadErass W appGlnnC(number antl street ary, stata, and LP m
Pem,on auNorrsed Oy E�Ay exewted Prnwer of Atlwney or by IC G7.1-12-0.7
AOtlresso(aWforaedperson (numbererMSbee(,cify,5fafe,arxlLPCOde)
oate (mon(h, aaY. Y�0
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