HomeMy WebLinkAboutMortgage_Besing (3) r"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township L Year
Ai' cedr: FOR DEDUCTION FROM ASSESSED VALUAT�
�`- -L3I State Farts 43709(Rn/6-09)
4��-'`».f'7 Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
II I d�p�t� Form Ned Coup
To be filed in person or by mail with the County Auditor or County Recorder of the coungr tdtereltf2 pity is located. LrJy/
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought County Auditor
2) Mobile/Manufactured Homes not assessed as Real Properly Must file uring the twelve(12)months
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for additional instructions and qualifications., GIBS. .
Applicant(owner or-rise _ el ,
. .:side) • • • •
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7 D. ' Key number/legal d Record number Page number
��-30� _000.01..7c oaf a o /3 azl6?
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,and year March 1, date of application or equitable miner?
U`1 OLJ 000 ❑ Yes ❑ 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,indicate below. Is the property in question:Annually Assessed
/-y ❑Real Property ❑Annually Assessed
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Name of mortgagee or contract seller /— • Oa / r` / / _ r' Mo�1a Horne(IC fr1.1-7)
Address of mortgagee or contract seller(number and street,cal,state.and ZIP code) (`! \ ����/)✓/1r.J��,
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
•
Does applicant own property in any other I If yes,what county? - What Taxing District? Has this deduction been requested on property
r L.-flinty in Indiana? for anent year?
1=t_..__ .I_I_.r____ -- ❑ Yes ❑ No
Drawer NO OI� COUNTY AUDITOR
s�/�
(
i Card NOD. c2 _ 20 20 20 20
3-3•Cso _ O O County Date(month,day.Year)
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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/contract buyer of the aforementioned property on date application is filed.
Sig owners N//9 name)4 Date(month,day,year)
tresides address of appican S a m saaet,ray,state,and ZIP code)
q r E. 0atr } 111. I Yo. k -SroncI1 It9 ri-6igr
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) .