HomeMy WebLinkAboutMortgage_McEllhiney STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Township Year
"'' : FOR DEDUCTION FROM ASSESSED VALUATION
�t-:" j= Pres Porte by Department/t-09)Prescribed by Depamrom of Local Government Finance
INSTRUCTIONS: i I !i' ;'_`
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. SE I my Auditor
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file during the twelve(12)months 6❑2
before March 31 of each year the deduction is sought - ❑ iedlinty Recorder
See reverse side for additional instructions and qualifications. ,A
Applicant owner or contract buyer-see restrictions on ..e side) x
GIB `��ry'N`Nj•Gi�
(1/111C COUNTY AUDITOR
Trod Ot,sbict Key number/legal desolation Record number Page number
Q w d a° - 0a - el / - trod. 8o / - 00 / /3 1x58°
Assessed value of real property as of Mortgage/Contact Indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
Mardi 1,and year Mardi 1,current year date of application legal or equitable owner?
70aoo ❑ 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
❑Real Property ❑Annually Assessed
- Mobie Havre(IC 6-1.1-7)
Name of mortgagee or contact seller
s.6.
Address of mortgagee or contact seller(number and steel - ate.--•ZIP code) _ _
Name of assignee or other owner or holder of mortgage /jz
4
Address of assignee(number and street,city,state,and ZIP code) / n i
Pr w NE a - 3 - 9 /. A73g1 f}c �3-z/5CY/ J
Does applicant own property in any other If yes,what count'? • What Taxing District? I
county in Indiana? J
❑ Yes ❑ No
COUNTY AUDITOR _
Deduction approved in the amount of:
20 20 20 20 20 '20 20
Signet of County Auditor 6 � County Date(month,day,year)
,
I/We certify under the penalty of perjury that the above and foregoing information is We and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
k. (2.• // Date((month,da year)
Full resident address of applicant(number ati street,city,state,and ZIP code) •
Xs/a93 S 1p:IS"F Op/'G/an,) Lif-y / TA/ 9. 7660
Person authorized by duly executed Power of Attorney or by IC 6-1.1- -0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)