HomeMy WebLinkAboutMortgage_Breidenbaugh STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r FOR DEDUCTION FROM ASSESSED VALUATION
Pre sa cr iibb e d by Department of Local Government Finance F I L I D
File Mark
INSTRUCTIONS:
Form filed with
To be filed in person or by mail with the County Auditor or County Recorder of the county where the perry is located.
Filing Dates: I) Real Property:Must file during the year for which the deduction is sought J U 19(t n i 3 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Properly Must Re during a twelve months
before March 31 of each year the deduction is sought - County Recorder
See reverse side for additional instructions and qualifications. I • ' ��n111wi
,�r,(.L . ern, ,baye - ��� 1 .) ._i..w ,`A so` 4 i • DI
C. .11.Q1^ { Kay l '•1 (J- ICY - /b-3- JT -Or) / 38/-0 drt •• •nu hP Pa9 as's
•-•value of real propeny
as of Mortgage I Contract�'p�tedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the apptvnt the sole
March 1,amen year tAarrJ1 1.crenent y O� date(14°mtion legal or Yes 0 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,Mitigate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
^ Mobile Hone QC 6-1.1-7)
Name of mortgagee or contract seller ..36\
Ad— and ZIP code)
Q013(•Dray► :...................
Ada.
Cara No. ... .5.. . ..... .
Doe 491 3 J , __ nty? • What Tatting District? Fias Na deduction been requested Yam property .
CPS. Y/ O'`,f/.f (1"— for anent year? ❑ No
COUNTY AUDITOR
Deduction approved In the annum at
20 20 ,{Dy'y) 20 20 20 20 20
Sig of ry��V u .)l I ' ` I County Data(month,day,year)
I
I We certify under the penalty of perjury that the above and foregoing information is bile and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Inawre owners tuff name) Date(month,day,year)
ti. AA. l .. !_ A If , II
Full resident address of applicant(num•:rand street.city state,and ZIP code
cis a3"I; C• 1c it- . Qtr nc c1Y1 , I1k1 y1(6q
Person authorized by duly executed Power of 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) .