HomeMy WebLinkAboutMortgage_McIntyre (5).� � STATEMENT OF MORTGAGE OR CONTRACT INDI
_ FOR DEDUCTION FROM ASSESSED VALUATION
- s�ie � aa�os �rxs i zo�>
S I Resaibed by Depanmmt W local Govemmerit Firance
�sr
Coun Township Year
�
File Mark
�NSrnucr�oNS: OCT 2 3 ZUU�
To be filed in person or by mad with tlie CountyAudifor o/ the county where fhe pmpeAy is located.
Fding Dates: 1 J Real Property: Dunng the 12 months be(ore June 11 0/ the year the deduttion is to be eflective.
2) Mobile Homes assessed under IC 61.1-7: Behveen January 15 and March 2 0( U�e year the deductim is to�-e� �ve. ? i
See reverse side /a additional ins6ucfions and qualificafions. O��6"� N�`�`}j
m
Ta�u siri Key nupi6er / legal desaiplion � �`' i � Ll o� � v�mU P (p O/
(p �7
Psessed value of 2al propefty as of Mairh i, anent ymr Mot�qage / Contraa indeWedness unpaid as of Ma�ch 7, s Ihe appficant ihe sde legal ro equitahle o.vne(7
�rt�`rear dd`rGav ❑Yes ❑No
If ��hat is his / her ezad share of iMerest? If owned wilh someone dher ihan spouse, indicate wifh whom.
If name m remrd is difFereM �han Ihat of applicanf, indimte belav: Is Ihe properry in queslion:
❑ f2ea� Frooertv ❑ Mwzle r+«re nc s,.�
Name of mortgagee or wnUacl y�{�r /
���1
Address of mo�agee a conUaC sdler (
Name of assgnee a alher owner a hol
Address of asvgnee (num6er arM streel,
Does applicaM awn propeRy in arry oNer
caunty in Indiana?
❑Yes ❑ No
Deduction approved in lhe amwnl of:
20 �n. 20 _
r
s{gnawre of Counry Audi�nr
/ 7'"(�
n raiM�ee(,tity,sfate,ard:
der of mwtgage
dty. 9ate. and ZIP cotlel
If yes, whal caunly?
COUNTY AUDITOR
2p 2b 20
County
�s
�D
uJ ' ,:..
, , �e` �o- �.y o , v''
��a ��.- sy�
�?`�
� oeen requested on WoP�y
��
❑Yes ❑No
20
20
I! We certify urWer the penalty oi perjury ihat ihe above and foregoing infortnation is true and correcl and tliat fhe applipnts was l were a resident oi
Indiana and owner of the aforementioned property on March 1, 20
SignaUUe ( 1fid�Cia. rne) / �^ . , ' . . � � /, 7--� Date (month. day. yee�
of
�
Adtlrrss af auUrorized person (num6eraiN sbeel.
/�� e�'��y �
'L�TOI�I �-�� l z176 7�
Date (manfh, daY. Y��