HomeMy WebLinkAboutMortgage_Johnson -���,"i_� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year I
FOR DEDUCTION
/6-09)FROM ASSESSED VALUATION .
f State Form
Prescribed by Department of Local Government Finance g
y �,f.` File Mark
INSTRUCPONS: 11 1 �..J t I
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form filed with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. i i) (ono County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file dune Nl
before March 31 of each year the deduction is sought - County Recorder
See reverse side for additional instructions and qualifications.
AppSpr51eror.. buyer- anre side lingiticcigar-
'n��'Ar � fi � IB ON COUNTY AUDITOR
TaxintC Uja ; ' f Key number I liV d tion Record number I P,�ge number
��1 « �P a � aa�- 000rsa3 oa6 /3 �r'4/3
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Martin 1,axmn year 1,arrtenttrar date of application legal or equitable owner?
a s" o ❑ Yes ❑ No
If no,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 ❑Annually Assessed
Mobile Hone(IC 6-1.1-T)
Name of mortgagee or contract seller 5!3
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sweet city,state.and ZIP code)
Does applicant own property in any other II(yes,what county? - What Taxing District? bias this deduction been requested on property .
county in Indiana? current❑ Yes El No for current year?
❑ yes ❑ No
COUNTY AUDITOR .
Deduction approved in the amount of:
-
20 20 20 20 _ 20_ 20 20
S9na ty Auditor ' D - � �.p • County Date(rrnnth,day;year)
"AA.1 r' 6 6-07/3
I/ e 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
comer I contract buyer of the aforementioned property on date application is filed.
/ySii1g (owns name) Date(month,day,year)
/�Fu/ca reIs/ide/nt xdd�res ion aopucan n of and*set,city,slat d ZIP code)
y/ t 0) S. /r•t e(!/Ai+O/ / /. k JC Ar Cy1 iT N z-/-26v?
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)