HomeMy WebLinkAboutMortgage_Pollock (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year I
e '`
FOR DEDUCTION FROM ASSESSED VALUATION
Sate Farts 43709(RU/609)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: F
To be filed in person or by marl with the County Auditor or County Recorder of the county where the property is located. e�9 1��
Filing Dates: 1) Real Properly Must file during the year for which the deduction is sought. �C�9'nfv
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months El County Recorder
before March 31 of each year the deduction is sought Y
See reverse side for additional instructions and qualifications. �y�. MAY 21 2f113
Appfcant(owner or con uyer-see restrictions on / �Lr�u J '/l �I
Taxing District ben/ I d p' umb/R�r
otr - I I 7D(-cot ais- pBSONCOUNTYgUntrg�
Assessed yarn of real properly as of Mortgage/Contrail indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
Match 1,amens year March, yea!_ date of application legal or equitable owner?
/l/ll/7�l ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,mdimte with whom
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(1C 6-1.1-7)
Name of mortgagee or contract seller - tia 0 /�
Address of mortgagee or contract seller(number a f•C
Drawer NO X I-3
Name of assignee or other owner or holder of man /'� ,�/1 Yr�9
Address of assignee(number and street,sly,start Card NO. c 1/y6��/ co
Does applicant ❑ Yee other
❑ No I Soy wl/I o current t year? been requested on property❑ No
❑ Yes
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor • County Date(month,day,Year)
I 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 t contract buyer of the aforementioned property on date application is filed.
$prraawe( rteL fool name] k Date(rtpnN,day,year)
F^y%3 Coyt address�/Lgf 9A `•p6zrber 4 city,state,and ZIP code)
Person author�dt by duty executed Power of Attorney or by IC 6-1.1-12-03 Date(month,day,year)
Address of authorized person (number and sbee4 say,state.and ZIP code)