HomeMy WebLinkAboutMortgage_Moers _ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS g Cct� ET T Year
�� ;. FOR DEDUCTION FROM ASSESSED VALUATION
���.� �aa�m�709(R„/rD9) JUL l 22013
Presodbed by DepaNrrent of Local Government France
File Mark
•
INSTRUCTIONS: _
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is
with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. GI BSO N C OU TY DPFEJR 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 - ❑ County Recorder
See reverse side for additional instructions and qualifications.
Appfxant wn or �i:.buyer-see an reverse sgigt
Ta ig Distil- Key number/legal description Record numberPage number
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• _.value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole
f•`,,amen[year March 1,aurent date of application legal or equitable owner?
a/ � ❑ Yes El 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
properly in question:Annually Assessed
❑Real Property ❑AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and stree ' ;state, ZIP code)
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 If yes,what county? , What Taxing District? Has this deduction been requested on property
county in Indiana? a Yes ❑ No for current year?
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved In the amount of.
20 20 20 20 20_ 20 20
Signature of County Auditor 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/contract buyer of the aforementioned property on date application is filed. _ --"' "
Signature(owners full name)),, Date(month,day,year)
WJ t� C r. r I
W resident address of applicant(number and street city,state,and ZIP code)
1666 F /Rca r, H4 vasr�9 ' r— y-)6.3 5
P�n authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of audwized person (number and sheet icily,state,and ZIP code) .