HomeMy WebLinkAboutMortgage_Brittingham (2) ,+_" . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County
'1� Township
Township I Year
F„'_.._ FILED
FOR DEDUCTION FROM ASSESSED VALUATION
°s� Slate frortn 43709(Ri t/609)
Presaibed by Department of local Government Finance
File Mark
INSTRUCTIONS: r:e• ,710,.ai j •
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 Court Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought- 1,r ,il it it Recorder
See reverse side for additional instructions and qualifications. G I BSO • • i • • • i 11 -
Apar(owne,or 7buyer- .. ;.. on averse )
Ta is Ke number/leg •"paon Record number Page n
g /a. -.. ,�3 -/a0-lG� 065- n0 2 do/3 /a//
Assessed value of real property as of Mortgage/Contraa indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appacant the sole
March 1,current year March 1,wren year data of application �( legal or equitable owner?
/A O00 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If awned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below. Is As
property in question:Annually Assessed
Real Property ❑Annually Assessed
• //,, Mobile Home(ICS-1.1-7)
Name of mortgagee or contract seller /// n i
t is_
Address of mortgagee or contract seller(number and street city,state.and ZIP codd-
Name of assignee or other owner or hatter of mortgage
Address of assignee(number end sweat,city,state,and ZIP code) /eA71 A 'N" g
Does applicant own property in any other I If yes,what county? - What Taxing District? Has this deduction been requested on property .
manly in Indiana? El Yea- ❑ No for current year? ❑ Yes ❑ No
COUNTY AUDITOR
Drawer NO
C2018
_ 20 20 20 20
•
1 X017
Card NO. County Date(month,day,year)
•
41 I 0 2 i 34?. CiO-
ove and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementtone0 property on date application is filed.
Signature(o�,,� name) Date(�Y.Yce
X 3
Full-resid tad. :. of ap iefenu ryrr}street, : •nte,and ZIP code
/ ir ,gr 41
Person authorized by duly executed . of Attorney or by I • 1.1-12-0.7 Date(month.day,year)
Address of authorized person (number and street city,state.and ZIP rode) - - _ ._ __._