HomeMy WebLinkAboutMortgage_McRoberts STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
� : FOR DEDUCTION FROM ASSESSED VALUATION
`._s'" I! State Form by De artm/6a09) �\
t1,,b Prescribed M Department W Local Government Finance LED
INSTRUCTIONS:
To be filed in person or mail with the County Auditor or County Recorder of the county where the property Farm2 wit,
Pe by ry N h P Pent k located. J U L
Filing Dates: 1) Real Properly Must file during the year for which the deduction is sought L J 'Cbh/lry 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 - n E„ Co �' er
See reverse side for additional instructions and qualifications. GIBSON CEO-U-NfJtYAUU1 I UK
Ap nt(owner or contrac(tbuyer-seeresstrrinwu on re side)
Ta DistrlCt Key number/legal description Record number Page number
/t,c,tA.cve� a!o -- /I -/01 /o3-Da/. 7 Sy-o l? ?o�3 X 93 /
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
March 1.anent year March 1,cement year date of application Q legal or equitable owner?
SO C/ gf ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other-Chan spouse,Pndicate with whom
If name on record is different than that of applicant-indicate below 'Is the properly in AnnuatyAssessM—
I—
\ !��( 1
Name of mortgagee tract seller Drawer N O..•r^,T[•.0 . ....••
•Address of mortgagee or act seller(number and street,city,state,and ZIP code) i '.. 1 •�w-•w•••.
Card \O. . G
Name of assignee or other owner or holder of mortgage 4 5 g9 ao
Address of assignee(number and street,city,state,and ZIP code
- h 74 /09 1'r /Bo Pr—
Does applicant own property in other If yes,what county? • What Taring District? Has this deduction been requested on property
county in Indiana?
El ❑ No I for current yea? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved h the amount at
20 20 20 20 20 20 20
Sigratu of
County Date(month,day,year)
I 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.
Sig .,.re(owner's name) I Date(month,day,year)
I li Y}J
Full },•en s-cad of t(number abee4 city,state,eM Pcode)
Full
ail, I.?Lao . U +ale a�. �n N76,7a •
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) .