HomeMy WebLinkAboutMortgage_Heldt (2) `� _,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS o n . Year I
FOR DEDUCTION)FROM FROM ASSESSED VALUATION
tottiAW Slate Farm 43709(R1l 16-09 resit
t Prescribed by Department of Local Government Finance JUL �blfir
INSTRUCTIONS: Ul_ gds
Form filed with:
b be filed in person or by mad with the County Auditor or County Recorder of the county where the properly is located
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. ��_�/ .unty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property.Must file during the twelve(12)mon / Tfrr
before March 31 of each year the deduction is sought - GIBSON COJN ithAftifitIrrd el
See reverse side for additional instructions and qualifications.
Appasanwner or tract -see an reverse site)-r
Taring D' JKey number/legal d • J\ Record number Page number
ti_ (4..j,.._ a(, -VR-act - aaa - Cta . Nog - acts rd2bI. C1 la
Assessed valve of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the spotrent the sole
March 1,and year March 1,current year date of application legal or�eqyu�itable owner?
Le C O S 1 lypnres_❑ No
If no,what is his/her exact sham of interest?
If name on record is dfferem than that of applicant.indicate below; /_-N ��
• v ,� l, 1.1-7)
Name mortgagee or contract seller
5 .'3 • �O n n
Add of mortgagee or contrail seller(number and steel,ray,state,and ZIP code)
Name of assignee or other owner or holder of mortgage Si
3 Address of assignee(number and street,city.state,and LP code) �,/IIII
Does applicant cam property in any other If yes,what county? - What 1
county in Indiana? ,,��,,��
El Yes ^ 5 • /. No
COUNTY AUDIT( i U
Deduction approved In the arrant at
20 20 20 20 3-C9 0 J 2 l l_X I/' ) 0
Signature of County Auditor County .
_ f
I/We certify under the penalty of perjury that the above and foregoing information is i -
owner I contract buyer of the aforementioned property on date application is filed.
Slgreaure ogn name)"7l'e.r
F resident address of applicant(number end street city te,and 21P code) �'//
3 /V E' 90 O -S c . k''•la n.C�, 76 t —
authorized by duly executed Power of Attorney or by IC 6-1.1-124.7
—
Address of authorized person (number and street city,state,and LP code)