HomeMy WebLinkAboutMortgage_Willis (2) ESTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.
FOR DEDUCTION FROM ASSESSED VALUATION
r'_' 1= state Fond 43709 Department nt 6-09)
of
r _ Prescabed by Department of Local Government Finance
INSTRUCTIONS: tied with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.o C T Q 3
Filing Dates: 1) Real Property:Must file 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 - ecorder
See reverse side for additional instructions and qualifications. C I DSON COUNTY AUDITOR
Ap t(owner r✓contract b uyer-see side)e)
40 `F- n / 1 � _
Key number t legal description I
Page T � t-4--)301° 2-( -- i -0/ - /Op- o o a . 16 a -o a 7
'Record f 36
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contact indebtedness'unpaid as of Is the applicant the sole
Mardi 1,current year March 1,parent year date of application legal or equitable owner?
S a, o op I ❑ Yes ❑ No
If no,what is his I 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
I Mobile Home QC 6-1.1-7)
Name of mortgagee or contact seller
Address of mortgagee or contract seller
Walls, M4
Name of assignee or other owner or hal
in m,14-<_tA L
Address of assignee(number and stree
Does applicant own property in any rata 1 1 1-x. /r"� I v" Has this deduction been requested an property
county in Indiana? for cumin year? ❑ Yes
❑ No Yes i3-5�( J
I
Deduction approved in the amount oft
20 20 20 20 20 20 20
Signature f County Auditor • / ' County I Date(month,day,year)
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.
)Slgraarre(owner's full naTme) / . Q/� I Date(month,day,year)
/ t v' `✓CCC-Col
X Fug resident of applicant(number and street,a1};ate, ZIP code) i
/ ' /J 3 a . 07,/ pc 14€/� y/ 1r,r�k., Iv. 171,7iI
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 / I Date(month,day,year)
Address of authored person (number and streeL,dry,ate,and ZIP code) I _ __