HomeMy WebLinkAboutMortgage_Nixon (6) STATEMENT OF MORTGAGE OR CONTRACT IN
7:sT - tg-� �`� j �ty Township Year
--: FOR DEDUCTION FROM ASSESSED VALUATIO
f' State Forth 43709(RH/6-09)
Prescribed by Department of Local Government Finance rl
INSTRUCTIONS: MAY 2 2013 File Mark
To be filed in person or by mail with the County Auditor or County Recorder of the county whe - he pm.- • , Form fled -
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. firm,E U County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file dud - •- - `
before March 31 of each year the deduction is sought GI B SON COU '1 1 1 V R County Recorder
See reverse side for additional instructions and qualifications. y
Applicant(owr�,/y�naaGbu�er see/p5ri,°°849'�ver ide) `//i / " —l^ [�� Q
Tab l`///^'/W` t•.Y/ICe•!J� '7//JJt�Qm ///��al'/,P(— 3 3 a/"O Uo Q 7 TCAT� Rem number Pa9116 7
Assessed valued real property as d e/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid asofof Is the applmnt the sole
Mardi 1,crsrent year Marr3r 1,cunent yrnr y� date of applintion legal or equitable owneN
ODr) ❑ Yes El No
If m,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,indicate below: Is the property in question:Annually Assessed
❑Real Property ❑AnnualiyAssessed
Moble Horne(IC 6-1.1-7)
Name of mortgagee ar contract setter t �S y1 �r _
Address of mortgagee or contract seder(number end sheet,city, tare,annd`d ZZII/P✓coode)
Name of assgnee or other owner or hool/deryroof mortgage
Address—W c10-IC.(,J-'5
l O i-4 /� C inty? What Taring Distract? Has this deduction been requested m property
n 1 1�/` /I for anent yeaR ❑ Yes Ell No
U / Z . / I( ` COUNTY AUDITOR r
•ZU 20 20 20 20 20
Signabae. c.) ty Auditor / County Date(month,day,year)
I
I I We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
range(otwrets M Loame) Date(month,day.year)
jth
resident adddressd applicant(number and stree4 cloy,state,end ZIP code)
/t,�_, °1a8 E. Euan.a pb..w�.je... ire '(D(0)a
'P Jerson authorized by duty exeaaed Power of A torney 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)