HomeMy WebLinkAboutMortgage_Matthews a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County_ _LIED Township Year
FOR DEDUCTION FROM ASSESSED VALUATION T •
=i" 1: State Pond by De artm/609) Jl
Presrnbed by Department of Local Government Finance
F INSTRUCTIONS:
To be filed in person or by mail with the Court Auditor or County Recorder of the court where the properly Fortin filed
ve y County is county P Penn slocated. SEP 2
Filing Dates: i) Real Property:Must file during the year for which the deduction is sought. 0 1aunry 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 - n ❑n County Recorder
See reverse side for additional instructions and qualifications. ,^W^`Y
Av an,,(�J • • on inverse,;+„ GIBSON COON f Y AUDI fOR
Ta ' Distict Key number/legal desorption Record number Page number
av ae - /d - / 6- doo - bag. 3 r 7 - o et ) /3 474 $
Assessed value of nil poperi/as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
Maras 1,anent year March 1,current year date of application legal or equitable owner?
159 0 50 ❑ Yes ❑ No
If no,what is his I 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 property in question:Annually Assessed
❑Real Property ❑AnnuallyASSessed
—���, Mobile Home(IC 61.1-7)
•Name of mortgagee or contract seller 6 /3 f)59�_ /•,37-'
•
Address of mortgagee or contract seller(number and street city:ate,and ZIP code) �O. 'r`-'W lrip •0 ?
Name of assignee or other owner or holder of mortgage �� ill A4 _ - •
�f1p�1� �}' �y� 1 ) Tf
Address of assignee(number and street,city,state,and ZIP code) "`'w J 1. , 'r /Clilike400 4-840°L.
Does applicant own properly in any other If yes,what county? - What Taxing Dist:err
county in Ird'ana? ❑ Yes for dent yra,.
❑ No l current L I Yes :] No
COUNTY AUDITOR .
Deduction approved in the amount at.
20 _ 20_ 20_ 20 20 20 20
Signature,W County Auditor 4- ` County Date(rr»nth,day,year)
/t/T�/frA�l`/,1�� 71--.y`"v3y71/4-
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.
Sig ,Ia(}/yree(owner's full name) Date(month,day,year)
y 1 Full resident address of app nt(number and street,city,state,and ZIP code) II fit' ')
I� (pq S , eet`s : r•-tr. ct LA/, Pr;^CJzn 5T/V . Lf71f(/
Person authorized by duly executed Power of Attorney or by IC 61.1-12-a7 Date(month,day,year)
Address of authorized person (number and street city state,end ZIP code) .