HomeMy WebLinkAboutMortgage_Hardiman"�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear �
_ • FOR DEDUCTION FROM ASSESSED VALUATION
�� Sfate Farm 9.7709 (R71 /6-09)
�` � pi¢scnbed by DeP�ent ot Laml Govemmenl Frwice
WSTRUCTIONS:
To be fiied in erson or 6 maB with the Coun Auditor or Coun Recorder o! fhe coun where the ro C F � '
P Y �Y 4' N P PertY is located.
Filirg Dates: 1J Real Pmperty: Must file dunng the yrear (or which �he deduction is soughG r B . Co nty quditor
2) Mo6Ae /Manufadured Hortres rrot assessed as Real Prnperty: Must file dunng tAe twelve (12J months ❑
before March 31 0/ each year the deduction is sayht - � �
See reverse side for additiona/ insfructions and qualifications.
M (mvxrwcontiaCbymr'se/resMCionsmreverse ' � , � _
oistri Key rvanher / j�ai desaiPtion
2,(0-�' s-3a-�oo-�o
Assessed ralue aF rrai popsty W Mor�qa9e/ Contract Inde6tetlness unpaid as of
Ma�rh 1. cvrefrt 1� Mam1� 1. amenl yeer
tt ro, whal is his / her exaU share of interrst? H ovmed
If name on 2m'tl is dftr�ft Nan Nat ot app6�nt h�dicate 6eluw.
���,�� 513
Name W assignee or other owner w halder of mort5
PA�of assign � urtNeraM sveet, ary,state,
-i E N u�
Dces eOP�irant own property in any oNer
LJ No
approved in Ihe amount af:
sfate, aM ZfP code)
7d ^1^Iv
If yes. wha[ count�?
2� _ , 20 _ , 20
Recotd numDel Page numbu
—OoL % .ZO/ �—�'�i
u[ u�debce0ness unpaid as of Is the appfiont the sole
i legai ar equilaWe ownrYl
� s ❑ Yes ❑ No
°l I�12(15�pU$Q. pl�lp�8 NtUI W�Wfll
Is tl�e pmp�cy in Question: MnuaOy Ascs�xd
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sgnawrn at [ �mrynwrtv C.�
I I We certify under ihe penalry o( perjury that the above and (oregning infortnati �C� � O I��� V�
owner I contract buyer af the afwementioned property on date applicatlon is file
� SiBn�a (omre/x ma �
�� ti/
Rsident dapp6wnt(numberaMStree;dN. .endLPCOtle)
�� S5 A/ S —� i 1?V �4 �c�
Pgson auNm'¢ed �y duly exewted Paver o(Attnmey or Cy IC 61.1-12-0.7 Oate (rrpnM, Eay,
person (numDerarMSbee;ciry,sfata,e/+�LPmde)
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