HomeMy WebLinkAboutMortgage_Hale (11) Y��: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County ••) ip t
FOR DEDUCTION FROM ASSESSED VALUATION
�' IS State Farm 43709(R77/609) It
x"- Prescribed by Department of Lod Government Finance .
Fir ark
INSTRUCTIONS: . I 1 I
To be filed in person or mail with the Court Auditor or County Recorder of the county where the roe Foy��
Pe by ry ry ty property rty is located.
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought r Count Auk•
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 Ill �' ,!)�A!!R[I
See reverse side for additional instructions on reverse Cal • . • AUDITO'
Agar I owner or con..`uyer reverse side)
a• • •... 4 Key n ben 1 I desorption/ / Record number Page number /
076 -(2-- /- V00-DU/ 07c-1062-/ pall/ 53
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year arch 1,current year date of appfication ^i legal or equitable owner?❑ Yes ❑ No
someone no,what's his/her exact share of interest? If owned with som �e other than spore se,indicate with whom
If name on record is different than that of applicant,indicate below: Is property in question:Annually Assessed
Real Property ❑Annoy Assessed
-
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller �j .
•
Address of mortgagee or contract seller(n and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
•
Address of assignee(number and scree;city:state,and ZIP code)
•/-/-/jl�)/ / . 3 - /0) /c2,1` e,
Does applicant own property in any other If yes,what county? • What Taxing District? Has this deduction been requested on property
aunty in Indiana? ❑ Yes ❑ No for current Yeah ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
—
20 20 -_ - 20 20
Signature of County Auditor ASE Rey Date(month,day,year)
I I We certify under the penal d"13 - 3 aartect and that the applicant is a resident of Indiana and
owner I contract buyer of the
s. SkiAree art ifri / Date(month,day,year)
F - •• add- • apprrant(m _
t c'St 5 706 w Ow Pns Uill t m 76,4s
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of author iced person (number and street,city,state,and ZIP code) .
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