HomeMy WebLinkAboutMortgage_Douglas (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun !IMMISE Siai,
FOR DEDUCTION FROM ASSESSED VALUATION I� i it
Farts 43709(R11/609)Local r
Prescribed by Department of La Government FFinance I
6 fr47 2013
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form filed with:
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. I1, r
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months ' vJm1!l`�� .tor
before March 3/of each year the deduction is sought G I BSO r 0144-TV R@44l�T'O R
See reverse side for additional instructions. qualifications.
T.: .. . K: ,. r /leg- desoiption
OF m// 3 Page . .-
l - / - - a0- "St 1 -D.
30
value of property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,raiment year date of ap legal or equitable owner?
/I legal
❑ Yes ❑ No
If o,what is his/her exact share of interest? C owned with someone other than spouse,indicate with whom
If name on record's different than that of applicant,indicate below-. Is the property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller r:2/ — In/ '�,�r/n
Address of mortgagee or contact setter(number and•,/-7 city state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code
t „-_,,-/A j. 3,3c,
Does applicant own property in any other If yes,what county? - What Twang District? Has this deduction been requested on property
county in Indiana? year?❑ Yes ❑ No for current year?
❑ yes ❑ No
— — ., COUNTY AUDITOR
Dec
Drawer NO.. o
/� 20 20 20 20
•
Card NO. ..1 (X.
Sig. County Date(month,day,year)
I foregoing information is true and correct and that the applicant is a resident of Indiana and
to application is filed.
(owners tuft .. �-� Date(rronN,day,year)
fa .1/C['ul / --/Zi!col Y(r "�"""
F� resident address of appGant(nu r stree city, fe,fJfd P code)
I\ 405-$6, LL) S S, Oiven571///e . i`h W�Q�v6
a by duly executed Power of Attorney or by IC 6-1.1-12-0.7 r Date(month,day,year)
Address of authorized person (number and street miry,state,and ZIP code) . -