HomeMy WebLinkAboutMortgage_Mayes STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co f ' ? Year
1)�
�, ; FOR DEDUCTION FROM ASSESSED VALUATION
State ibnd by De (R11/609)
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File Mark
• INSTRUCTIONS: A• •
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. 0 Co ty Auditor .
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months ,I —I
before March 31 of each year the deduction is sought. •ivta'I . ty Recorder
GIBSON - • -
See reverse side for additional instructions and qualifications. - • • ir -
(owrerarmuraC buyer-see restnc6�wrsre e�
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Taxing District Key number/legal description Record mbar Page number
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Assessed d real d Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1, year ••� Mardi 1,cormnt year date of application
�� �Q, -'q'..��--/� legal or equitable owneR
if no,what Is his/her exact sham of interest? ff owned,ith`someone other than spouse,indicate with whom ❑ Yes ❑ No .
If name on record is different than that of applicant indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1A-7)
Name of mortgagee or contact seller ' 1
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Adtl of assignee(number and street,a state,and ZIP code)
Ir /d a) 3c pJ , 3 — /c) . 9-5 ca. 19 c.
Does applicant wee property in any other If yes,iwhat county? What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for content year? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of.
ZO 20 20 20 AbOl
Sig . -of Canty Auditor County
Drawer NO
`
er
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I I We certify under the penalty of perjury that the above and foregoing information is true Card NO. J V I
owner I contract buyer of the aforementioned property on date application is filed.
k �/ e na,�:.. _ LEI 501 . 0-- —
Full resident address of applicant(num•(r and street,rdy,state,and ZIP code)
K JOf 2LA) e0 Rd 9r� 5 S . •
Person uttoraed by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Add authorized person (number and street dry.state.and ZIP code)
(1-4-1-4.7 cH � . 4J7 3 3