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HomeMy WebLinkAboutMortgage_Williams (8) 4r-,104-.. FO E T MORTGAGE CONTRACT INDEBTEDNESS BTEDNESS County h Year FOR DEDU CTIO N F ROM AS SES SED VALUATION State Font 43709(R11/609) Prescribed by Department of Local Government Finance I File Mark • INSTRUCTIONS: Form �:� I To be filed in person or by mall with the County Auditor or County Recorder of the county where the property is located. Filing Dates: 1) Real Properly.Must file during the year for which the deduction is sought. E :CI:nty 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 GI: • .•)_, yr!{»%rr.�See reverse side for additional instructions and qualifications. 1 DITOR AppGCant(owner or bon...buyer-see•/on reverse side) Tad strict Key numbli/legal desorption Record number Page number , a6 - ao -.1s, aoo -DO T . 3 ) Z -ooh as (3 3&'S6 Assessed 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,aired year March 1,current year date of appfcation u p legal a equitable ovmer? I A D O 0 ❑ Yes ❑ No If no,what is his/her exact share of interest? If owned with someone other than scour"indicate with whom If name on record is afferent than that of applicant.indicate below Is the property in question:Annually Assessed ❑Real Property ❑AnnuallyAsessed • _ __ _ Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller i - C, —]' FCu DralverlNO c9°6,5 Address of mortgagee or contract seller(number and street,dy state,and ZIP code) J • Nameofass er a ignee or other dvm holder of mortgage Card (NO. V f! Ad a of assignee(number and street,city,state,and ZIP code) ` � m1 /{n///° C N E /5 3 - 7 r 67 A c. 7 �i . Goes applicant own property in any other If yes,what county? - What Taxing District? I Has this deduction Peen request=up.1,...,....., county in Indiana? ❑ Yes ❑ No for current year? 1 ❑ Yes ❑ No COUNTY AUDITOR Deduction approved in the amount at 20 20 20 20 20 20 20 Signa�of untYAWita ,74 r'•"'i`-" County Date(rrondr.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. ' / Slllrmn (own lull name) 4`i'�^C 0 Date(month,day.year) XWI 1residdent address i(nu berand sheet ary%stattee,and ZIP code &7)I�,5"-0. r ©o/l, n�J Cf tv rA) Y 766° Person authorized by duly executed Power of Attorney or by IC 1.1-12-0.7 Date(month,day,year) Address of authorized person (number and street,city state,and ZIP code) •