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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Ise,�nys; 'fl J
FOR DEDUCTION FROM ASSESSED VALUATION
: .,�, State DEC 16 .014
� Prescribed by DepanmeM of Local Government Finance
File Mark
INSTRUCTIONS:
F
F be Dates:in person or by mail with the Cdunng the for or County Recorder of the county where the property is located. G IE SO� r�rTY
arm Dates: t) Real Property:Must file during the year for which the deductions sought. Q iblI tiolTOP
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deductions sought - ❑ County Recorder
See reverse side for additional instructions and qualifications.
TCng nt(psger�
at)._ $ _?sbjmbes/ 6�QZ 3�T^' ■ (y Qt.` `fnQ` ��.� Record number Page number
Assessed Glue �as of_\YtT«,,,J/� Qr l•Mortgage/Contract indebtedness J\ unpaid as of Mortgage agge I Contract dbbtedness unpaid �Ihe applicant lab e Distrir
March 1;awns year Mach 1,current year 1 date of application legal or equitable owner?
3QV • r tees ❑ No
If no,what is his I her exact share of interest? If owned with someone other than space,indicate with Mom
If name on record is QRerant than that of applicant indicate below. b property in question:Annually Assessed
I party ❑Anne Home 6-1.1-7)
r{rM�aame of morttggagee or seller
Address of mortgagee or con d seller(n and ay,Nate,and ZIP cede)
Name of assignee or other owner or holder of mortgage '-
Address of assignee(number and street,coy.Nate,and ZIP code) R
5"v 06 •
Does applicant own property in any other If yes,what county? • What Taxing D'stdd .n /1
manly in Indiana?
�..�✓'
❑ Yes InCifo
COUNTY AUDITOR 10_j'i_ 51 dO
Deduction approved in the amount of •
20 20 20 20 20 Au
Signature of County Auditor 1 County Data(month.day,)ear)
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property an date application is filed.
(own 1�1'rr��n rem Date(month,day,year)
Iv y( ■
1-I b5," H
Full f address of applicant(number al te,and ZIP code)
nit - W 591 11- ?21nttr n 1-4 4/ 4 to . .
authored by duty exeduted Poww. of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authored person (number and seee;city,as and ZIP code) .