HomeMy WebLinkAboutMortgage_Debord (2) STATEMENT OF MORTGAGE OR CONTRACT INDEB D E ,�os�y Township Year
IyFOR DEDUCTION FROM ASSESSED VALUATION State Farm 43709(RU/6-09)
Prescribed by Department of Local Government Finance MAR 1 •' 2013
File Mark
INSTRUCTIONS:
Form filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where ted.•
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought.
2) Mobile/Manufactured Homes not assessed as Real Property Must a b8&QI eSQA T4f n TOR County Auditor
before March 31 of each year the deduction is sought. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner orcontract 0)Z�73, m�verse � r/-�( J
T FLJI Key ber/lelegall description `/�C//Jl Record number Page number
dirt, ale - -f)s- -3G/ cy 3a11 0 13 13LI.<
Assessed value of real property as of I r�Mortgage/Contract Indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year Ma 1 anent year date of application legal or equitable owner?
?Li 6'9 -A) ❑ Yes ❑ No
If no,what is his l her exact share of interest? If awned with someone other than spot ma,indicate with whom
If name on record is different than that of applicant,indicate below.
is the property in question:Annually Assessed
eat Property ❑Annually Assessed
Mobile Home(IC 6-1A-7)
Name of mortgagee lact seller nl
Dginet� , gstw P
Address of mortgagee or contract (number tra seller(numb and street.city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
r+
Address of assignee(number and street, J� �__ - -
asst' ( say,state,end ZIP code) 5; 1, M/1
Pit
Does applicant own property in any other If yes,what county? What Taxing District? DHt73 t'0
county in Indiana? "'V
❑ Yes 0 N I Z J J_ ' rg5
COUNTY AUDITOR
Deduction approved in the amount of
_
20 20 20 20 20 20 I
Signature of County Auditor County Date(month,day,year)
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 -r• -tin ritioned pro rty on date application is filed.
t/\�Siigygn//a/�/pni�e(o fr -r ..me Date(month,daY.year)
�r7�resid: /n'ess of a.. t( •m(beerraanndd shoe city,state,and ZIP code) ._ .. .- _ _
P. .. •_•by duly 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)