HomeMy WebLinkAboutMortgage_Hartley (4)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Towriship Year �
: FOR DEDUCTION FROM ASSESSED VALUATION
s�ace ram as�w tai i i s-os)
5 1 pre�3ed by Departmen[ af Lnml Govemrnent Friarce
INSTRUCT70NS: �E
To be fited in person or by mad with fhe CourttyAudiror or Counry Recorder o/ fhe counry where the property is located. F r 1- I-S � 2 Q � 3
Filing Dates: 1) Real Pmperty: Must file dunng fhe year for which the deduclion is sougAL �� Counry AWitor
2) Mobile /Manu(actured Homes rrot assessed as Real P�nperty: Must file d�nng the hvefve (12) months
6etore March 31 of each year the deduUion is sayht "h'
See ieverse side for addrtional instnxtions aM qualficatnons.
MO�� (o q contraC,buyer- see res�irmns an ra�erse side) . � � ..
�'�°�
-,��-
aae / Contrac
at Is his / het exaU share of inteiesl?
cn recvrd is dAfereni tlun that o1 aPP��L hd�ate below:
�, \
Q Remfd number Pa9e numbnl
- O 8' S I
i as of Martgaga / Contru3 irdehtedness unD� as d LS Ihe sOPlkani the wle
date of appfmation iegal w equitade ovmM
❑ Yes ❑ ND
tt awned wi� someone other than spouse, indicate wifh whom
Is Ihe praperty in 9uestion: MnuaDyPSSessed
❑ Real ProPe�Y ❑ ��Y �
Modle Home OC 61.1=
Nym¢ ot mortgagea w contract seller
Address of rtwrt9a9ee or contracl seller (number aM stree; ciry, sfate. eM LP mde)
Narne m assignee or othrl owner or hd �FfJ�-� V' q ✓' E i� �`
/ ���E A
AdCress of assgnce (nurtibrr ared strec
Dors ePPliCant orm property in any oth I�^ �' �
m�,�ry�i�w,a? r-i .,--
amount of
I D'aGicl7 I Has ihis Eeduaion been requested on Droprny
r� a�i yeaa n., n,
20 _ 20 _ 20 20 20 _ 20 _ 20 _
Sig�uwre d Goimb nuditw Counry Date (month. daY Yead
I I We certify unEer �he penalty of perjury that the above and foregoing intortnation is W e and cortect and that the applicant is a resideni of Ind�ana aM
owner I contrad buyei of the atoremerrtioned property on date applicatlon is fiied.
SI9 (ownefs hID rema) Date (m�o1nth� daY Yae+� -f
� ' f A _ : _. n vL l, . si . ..✓ — � � � � 7
FW�ent aEtlres W app0eant (n� s6e ry, ffite, antl LP wde)
9 '
L� K/
P�sw� autfrorrzed by Ouy exewted Power ol Attomey w 6y IC 61.1-12-0.7
AEtlress af auVwr'¢ed prlsrn (numOerarM sbee; ciry, state, and LP mde)
�
o� p�u�, ear. res�i