HomeMy WebLinkAboutMortgage_Lance (2)^��* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Tovmship vear
:_-
• FOR DEDUCTION FROM ASSESSED VALUATION
� State Fam 93709 (R71 / fr09) 1� � 1
. S Presa�beC M �ePartment of Local GwemrtreM Firianca
� File Mark
\�sraucnoNS:
�
b be filed in person or by mad with Ne CountyAUditor or Counry Recorder o( the county where the property is bcated: .
Fifirg Dates: 1) Real Pmperty. Must file during the year (or which Ne deduction is soughL Coun Auditor
2J Mo6Be /Manufactured Homes irot assessed as Real Property Must fife dunng the M1veNe (12) �months-
befo�e Ma�ch 31 of each year the deduction is saght. ry Rec°�de�
GIBSO
See reverse side (or additional instructions and qualifications.
M (owrre�armnvaa6uyer-see2sf+k'.fionsonre a) ,
�
Tati�g �s4iU Key number / al Eesaiption O Remrd num6rl Pa9e numbrl /
a�-i/-9l_.3oo-ooy. as8.�-at 10l1, y�vs
Assessed d AWr�q�p e/ Conbau 4dehtedr�s unpaid as N Mongage I Contrul udebtedness unpaid as d Ls ihe appfifanl the sole
Ma`d� 1, amnt �ra March i, amen[ yeer \ date of appGcation kgai a equitade v.mM
I � � V ❑ Yes ❑ No
II ro. what ts h'a I hef eratl share Of interest? If owne0 xritA saneorie dher 5pouse. uMirafe with wlmm
If rwne m remtd is E'ittuent ihan Ihat ol appticant. i'Mitate below. Is tlre pmperry in puesUm: MnuaDy As,esud
�R� ��rtr O ��r � _
Name of nqrtga9ee or cmtrxt seper��
AAdress of rturtgaqee of contraG setler (number a�
Name W assignee w oMer owner w hoMer of mort<
MAress oiqs9gn e(n/� 4 tiry, s1eJ¢,
!!I / l�d
Dces appfirant wm property in any oNer
munry in Indiana?
❑ Yes ❑ No
/
De�ucUan approved in the amount of:
state. aM LP cde)
If yes, what muntyl
20 _ � 20 � 20
- -��`1f�2$�,UU
WhatTav� . .
DC��\'Cl' ��.....��•��....
�i��5...
c.,�-� �o . :.............
20 I 20
��
20 _ � 20 _
(monfi. tlaY• Y��
1/ We certify under the penalty of perjury Ihat Ne above and foregdng infortnalion is We and corteG arM that the applinnt is a resident of IrWiana
owner I mntract buyer of the aforementioned pmperty on date appl'�tion is filed. -
Peism
of authw'vtd persm (number aM sbee; ci(y, slafe, erd ZIP oode)
�i�l�5 T+�
\`�