HomeMy WebLinkAboutMortgage_Hall (9) A° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ' a r ty Tarn'" Year
liFOR DEDUCTION FROM ASSESSED VALUATION
GjiState Forth 43709(R77/6-09) I
Prescribed by Department of Loral Government Finance
OCT 28I W9ark
INSTRUCTIONS:
Farm Ned with:
To be filed in person or by mail with the CountyAuditor or County Recorder of the county where the properly is lowt=
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. m I, , .40,3r: County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twe/ve112)A. f( COUNT r Urecorder
before March 31 of each year the deduction is sought. l bb
See reverse side for additional instructions and qualifications.
App&ant(owne(or contract"ter-see restrictions on reverse side) . ,- 0D
/ a nn L S V/L/of
7a rig ct Key number/legal description —Record number Page number
b„ a Io-is -/k- (363aco i, oa /.-3 7 fir)
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the app&ant a sole
Mardi 1,anent year Mardi 1,anent year date of apprption legal or equitable owner?
/rd 000 I ❑ Yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone other than spouse,Indicate w;u whom
If name on record is different than that of applicant.indicate bebw: Is the property in question:AnnuaDy Assessed
.{,Real Property ID As
Annually Assessed
�" Mobile Home(IC 61.1-7)
Address of mortgagee or contract 1-r(number and street,city state,and ZIP code)
Kis l ->
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) Ii
Does applicant own property in any other If yes.what county? I 3- 7
q 0
requested at property '
county in Indiana?
❑ Yes ❑ No '0 Yes ❑ No
CC
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 rct buyer of e aforementioned props on date application is filed.
Signature frlrxename) Date(month,day,year)
F- resident 0 add�appfxant(number and street.city,state,ardZlPp�)
Person authorized by duly executed Power of Attorney or by IC 6-1.11-122 0.77 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)