HomeMy WebLinkAboutMortgage_Reinhart (4) •
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f STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun SZSICIl: f jj 1 I
FOR DEDUCTION FROM ASSESSED VALUATION ■ I I`
�t-" ".--„ 't-:J State Farm 43709(R11/6-09) (/�.,,
=�--=t Prrsabed by Department of Local Government Finance rlt far Z113
INSTRUCTiONS:
Form ced with:
M be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
i
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. 5• rr,;?7fy,-' .
2) Mobile/Manufactured Homes ar the deduction is sought Must tile during the twelve(12)months 01850 + O R MQ TO R
before March 31 of each
See reverse side for additional instructions and quaff-Peal s
Applicant(o or pa �on re sit
. ti / y�, 03 C'y/_DM / 56-Doi-Co 71dontlimbi p`numler
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the apokant the sale
March 1,current year March 1,cement year date of application Iegal or equitable owner?
de
/ ❑ Yes ❑ No
If no,what is his/her exact share of interest? I If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below: Is ropery in question:Annually Assessed
Property ❑Annually Assessed
^� Mobile hurtle(IC fr1.1-7)
Name of mortgagee or contract seller �`'(////' tl' //
Address of mortgagee or contract seller(nu and street city star,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,coy,state,and ZIP code)
Dces applicant own property in any other If yes,what county? - What Tatting District? Has this deduction been requested on property .
county in Indiana? ❑ Yes ❑ No for current year?
❑ Yes ❑ No
COUNTY AUDITOR .
Deduction approved in the amount of:
20 20 20 20 )
-_- -I
Signature of Colony Auditor Coo Av – 950
I 1 We certify under the penalty of perjury that the above and foregoing infonnati - ndiana and
owner/contract buyer of the aforementioned pro.- on date application is file
Nil■ ,t -0 h i IS—'0 .S!t?
iA resident address of a.. t(number and street state, ZIP code)
i 706 sees + Soo roc-0-4, t-t. Q2HNCtt, J. n) , hp}/ is
Person authorized 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)