HomeMy WebLinkAboutMortgage_Hedges (2) I
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STATEMENT OF MORTGAGE OR CONTRACT IN : k 1 ESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
'3 state Pam 037og(R„/ -09) JUN 25'20ti3
Pnsmbed by Department of Lod Government Finance
File Mark
INSTRUCTIONS: I 41711�1��r�1��
To be filed in person or by mail with the County Auditor or County Recorder of the ie :r Jib fywrawrr�R Ned
Filing Dates: 1) Real Property:Must file during the year for which the deduction isgh. ❑ County 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 ❑ County Recorder
See reverse side for additional instructions and qualifications.
Apparent(owner cc con”-.buyer- %�-•--: on re -side)
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Taring D" number/legal desaiptxxl Record number Page number
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Assessed value of real pa:petty as of Mortgage/Consact indebtedness unpaid as of Mortgage/Convect indebtedness unpaid as of Is the applicant the sole
Marti 1,anent year March 1,cement year date of application legal or equitable owner?
y�100 Q ❑ Yes ❑ No
If no,what a his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record a different than that of applicant•indicate be le te property in question:Annually Assessed
101Real Property 0 Annually Assessed
Mobile Horne(IC 61.1-7)
Name• •-•ee or contract ric
Add•o contract seller(number and street,city,state,and ZIP code) :: V Y+j.`_i' v-tee-
Name of assignee or other owner or holder of mortgage ../� 3...
0
Address of assignee(number and street,c%state,and ZIP code) C� , /)
DV Lill
Does applicant own property in any other If yes,what county? - V .•'- •••••• •• arty
county in Indiana? ❑ Yes ❑ No A S0• • No
COUNTY AUD ' Car 125-
Dedumon approved In the amount of ��
20 20 20 20 \ 20 20 20
1
Signature of County Auditor • County Date(month,day,year)
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 I contract buyer of the aforementioned property on date application is filed.
-Slgtialure( eYs me) /K,/y//��^��`i Date(month,day.year)
Full ' nt address of applicant(number a�$t tl%state ZIP e)
?� /23 bin sI-P1'e7 00001444 2N y7(1G
Person authorized by dolt'executed Power of Attorney or by IC 61.1-12-0.7 x Date(month,day,year)
Address of authorized person (number and street,city state,and ZIP code) .