HomeMy WebLinkAboutMortgage_Kelley��'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count ; w ip I Y r
S` �.` FOR DEDUCTION FROM ASSESSED VALUATION '
' Sca;e Porm <3709 (RN / 6-09) � Gibson Br 2
��^;�y'°� Preuribed by DeDartment of Local Govemment Finance .
INSTRUCTIONS: Fil �k 1 9 �UIU
To be filed in person or by maiL Form eieE vnm:
Filing Dates: 7) Real Property: Must be completed and tlafed in fhe calendar year tor which (he deduc(ion is soughL ��� �,y�
Must be filed with the County Auditor or County Recorder o/ the wunty whe2 the pmperty is locafed U.IiY���,^.!n'�v
on o� be/ore January 5 01 the immediafely succeeding calendar year. �j CoUJ+,ryRe
2/Mo6ile/ManulacturedHOmesnotassessedasRealProperty:Mus(TlewifhtheCountyAuditorolfhe (',CyUI'�t� . �T�
counry where the property is located dunng the hvelve (12) monfhs be(o�e March 37 o/each yeai the
deducfion is sought.
See reverse side for additional instructions and oualifications.
Appliwnt (ownerw mnt2cf buyer � see resMGions on reverse side)
•Helen M. Kelley
Tawig DisVict Key numGer / legal description Reeortl num6er Page number
Ft Branch 2G7 &2.4_204-000.658=026jPt Lots 299.306 and 307 La Grange Addition a U/p � �% (�02,
Auessed value of real property as of Motlgage / ConUact inGebtetlness unpaid as o( Motlgage / Con•,ract indebtedness unpaid as of Is the applifam ihe sde
Marrh 1, wrtent year March 1, current year tlata of appliwtion legal or equiuble owner7
72800.00 46000.00 ❑� Yes ❑ No
If no, what is Ns / her ezact s�are of interest? 1: owned vn:h someone aNer than spouse, inEicate with whom
II name on recorE is tlifterent than tha� of aDP���nt, intlica[e bebw: Is Iha pmperty in queslion: MnuaAy Assezsed
❑� Real Properry ❑ Mnualty Assessed
Mobile Hame (IC E7.7-7)
Name af mortgagee w mnvacl se0er
Firsi Security Bank
ACEress of mortgagee w mnVact seAer (number and streef, mty, state. and ZlPcode)
Name of assignee or other owner or holder of rtangage
ACCress of aszignee (number and sbee; ciry. sfate. anC ZlPcode)
Dces applicant mm pmperty in any other I� yes, what counry? What Taxing Disvia? Has this tleduUion been requested on property
counry in Intliana? ❑ for arrent yea�+
Yes No ❑ Yes ❑ No
COUNTY AUDITOR
Deduction apprweE in I�e amount o@
20 _ 20 _ 20 _ 20 20 _ 20 _ 20 _
Signa.ure af CounryAvditor Counry Da:e (mrn:b. day, year)
� I/ We certify under the penalty of perjury thai the above and foregoing infortnation is true and cortect and �hat the applican: is a residen; of Indiana and
owner / conVact buyer of the aforementioned property on date application is filed.
Sign t o s(ul/ namg) Date (mon[h, day, year)
�� 11-12-2010
Fu0 resiCent aGdress ot applicani (^um5er aM sUeet, u afe, aM ZIP code)
905 S Main Sireet Fort Branch, IN 47648
Persan authonzed by duty exewteE Power o1 Attomey or by IC 61.742-0 ] Dare (mmtA, day. yea�
ACdress of author¢ed person (numbe� and s'ucet «}: sfafe, and ZIP code)