HomeMy WebLinkAboutMortgage_Board a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
af' i` FOR DEDUCTION FROM ASSESSED VALUATION FILED
State Farm by De ttni/t-09)
Prescribed by 709(R neM of Lotter Daremmem Fuarce
INSTRUCTIONS:
To be filed in person or by mail with the CounryAuditor or County Recorder of the county where the property is locatitE 1 /F with:
Filing Dates: 1) Real Property Must rile during the year for which the deduction is sought County 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 , il h'Recorder
See reverse side for additional instructions and qualifications. R I R SO N COUNTY AUDITOR
Apr (owner or contract buyer 0-see on reverse side) X
T ' District Y Key number/I description Record number Page number
aLA-L-2 a6 -/a -a(o -/oo - vol. 276- 0 a7 a01.3 Li 95g
Assessed value of real property of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is me applirnt the sole
March 1.current year March 1,nnrtent year date of spin:m on legal or equitable owner?
/58�00D 0 Yes 0 No
If rot,what is his/her exact share of interest? r 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 ❑Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller --- /_''�
Address of mortgagee or contract seller(nube and sheet.city,state,and ZIP code) 7I�1 O i �/(/�-COo
Name of assignee or other owner or holder of mortgage Drawer NO l/�Q i.3
Address of assignee(number and street,city,state,and ZIP code) L1(�L� �/ _
/ A $ 9 ynecac Card NO. ... I[ Ir�(10 _
Does applicant own property in any other If yes,what county? • What Taxing D'c
county in Indiana? ❑ Yes ❑ No t _•
COUNTY AUDITOR
Deduction approved In the amount of:
20 20 20 20 20 20_ 20
Signs d County Date(month,day,year)
U
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.
XSig re(owners tutl name) /}s - Date(month,day,year)
Full resident of applicant(number(number and street,dryaly,state,and ZIP code) —
>, N . } vt...., At- . e/t-.- ..,c---
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 sheet,d4' state.and ZIP code) . •