HomeMy WebLinkAboutMortgage_Rich, ��a�v��� ���L�
(��E��MORTGAGE OR CONTRACT INDEBTEDNESS Count l
`a`�,�`== FOR DED)U(7�C(�TION FROM ASSESSED VALUATION
�.'�� �t�e F�rm�3ILV F�+I i / 6-09)
�",— Presuibed by Departmen: of Local Govemment Finance
INSTRUC ,�
To be filed i e 6y m � /+ Form
Filing��P„so.i.l �- ftype��� comp/eted and dafed in the calendar year for which the deducfion is soughQp�
��� be fle vnlh [he CounryAudi,or or Cowty Recorde� of the covnry vihere !he property is located ��
on or be/ore January 5 of the immediatelysucce=ding calenda� year. �
2J fAobile /Manutac,ured Homes nof assessed as Real PropeRy: Must file with the CountyAudit�i AQ. . C�
�u cu
aoun,y where ;he property is loca!ed dudng the hvelve (12) monlhs be(o�e March 37 0; each y�r '�he
deduction is sought. 171bS0� (�iOU(1ij�
See �ev_rse side tor additional instrucfions and quali�ca,'ions. �
Aoofirant fown=rer mnrncr n„�a, -�oP Aem�_,..,,� ..., .a..e,�e ..ue�
� Tacing
Assessed valu_ of real property as
March 1, airrent year
It no, wfia; is his / her exac[ share ct
Key
r/ le5al tl saip•i n �
> — ��'�e —7—C�"I
Mortgage / Contraq indebtedness
fdarch 7, cu:rentyear
It name on rerard is di7eren� Ihan tnat ef applirant, indiate below.
Nameofmor.gageeorcontra 1 el r I `
� � b'1 \ L('/ 1\
AtlCress ot mongagee or convact seMr (numbe� antl streel, ctty, s;ate,
Name of aislcnee o: o;�er owner or �older ot mortgag_
ACCren of anyn^e (number and street city. s:ate,
I Oces applirar.t o•.vn pmperty in any oNer
wunty in InCiana?
❑ Yes ❑ No
I Deduc6on apprm+ed in the amount o:: —
zo � 20 _
Signa:u;e
V
Coury Audi;ar
Caunty P,ecorder
1L" �V� C.�'� ��1\/V
P,ecord number Page nunber
._�bZ • 31- 6 `tOlb `f93ot
�aid as of I Mortgage / Cen•vact indabteCness vnpaid as of Is ihe appGant the sale ,
date of application legal or epuiable onneR
� ° Yes ❑ No
I: own^E aith someone oLher than spouse, Lidiw;e wi� w�hom
Is ;he pm7e ,ry In Cuestion: Annualryfssessed
[�'RealProperty � MnuallyASSessed
� Mobde Home fIC &7. L71
If yes, what munry? I VJhat Taxing DisVi�7
COUNN AUDITOR
za _ � zo _ � zo _
Has Nis tleEUCtion been repues:ed m prope ,ry
for current year7
❑ Yes ❑ No
zo � zo _
� I/\4�e cerJfy under the penalry ot perjury ihat the above and foregoing info i ation is true and correct and that th_ applicant is a�:=siden[ of Indiana and
owner / conuact buyer of the aforementioned proper,y on date application is fled.
�lnS�
son auNonzeE
Address
slate, and ZIP code)� 1
� �l rF L�- 4�i'
Culy exewted Power o(Attomey or by IC 61.1-12-07
person (numher and s(reet. ciry, s(ale, and ZIP crode)
I Date (rswnN, day, yea� �\
i�i.--�- � �1
�� �1� 3�
IDate (monm, tlay. yea�)