HomeMy WebLinkAboutMortgage_Church (2) t}: _ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun • i s:!p '•11 IE!7r,
FOR DEDUCTION FROM ASSESSED VALUATION .;
-a7y, Fart State Fo 43709(R11/6-09).,
'41-At- prescribed by Department of Local Government Finance
("INSTRUCTIONS: F'' '`6 2013
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To be filed in person or by mad with the Cowity Auditor or County Recorder of the county where the property is located. Form filed with: •Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought. lac '_ A• ,y t.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months •'y rr 4�y it
before March 31 of each year the deduction is sought. 01:S 4'0 CAt!': a.1 TO..
See reverse side for additional instructions and qualifications. .. - - -
Applicant weer• contract buyer-see on re site)
QA, v
T: 7t number/ descn Yon Record number p e��,�er i ii
/tie? rx� I/-I - oY- 300- ()Di ��o- oaV doll y�
of real property as of Mortgage/Contract indebtedness unpa' as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
ctsrerrt year Mardi 1,current year date of app45 /a legal or equitable owner?
.t/�'v ❑Yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone other than spouse,Indicate with whom
If name on record is different than that of applicant,hdicae below: Is property in question:Annually Assessed
Real Property ❑Annually Assessed
Manual Flame 6r1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(n a street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage /
Address of assignee(number and street city:state,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
❑
El yes ❑ No
Yes ❑ No
COUNTY AUDITOR
Deduction approved In the amount at.
20 r —_I 20 20 20 20
C;1uter-). -sci:Acy T
Signatun County Date(month,day,year)
Al)0 n
I 1W ng information is true and correct and that the applicant is a resident of Indiana and
ovum nation is filed.
1- 1,3-4/902) Date(month,day,year)
Twit.. dl—(9- )3
Full resident address of applicant(number and 4 city,stare,m..... _;
/do E 1 C0 S . 1- . �c�ct-�, IA x-111039
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
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