HomeMy WebLinkAboutMortgage_Memmer t zt STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION g g
t: State Forth 43709(R71/6-09) 1Al ftN
Prescribed by Department of Local Government Finance I L
File Mark
INSTRUCTIONS:
1 To be filed in person or by mail with the County Auditor or County Recorder of the county where the property PIXR1 1P;� .
Pe Y 4' h ry P PerfY is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. Court Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months • County
before March 31 of each year the deduction is sought IIII r•- f 'net.•See reverse side for additional instructions and qualifications. GI' a• • • g ` •UDITOR
Appacant_% orcontract buyer-40 lens--. •verse side)
`/ _I Ilb• Ca -
T.: s - I description .....number Page nun•
' I_ ' e0 sr.#- — O-Aso.. . . -QO 00 / . a
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage Io�Contoanct�indebtedness unpaid as of Is the apptlnt the sole
March 1,anent year March 1,current year date clap
b - I legal or equitable owner?
/ CM ❑ yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record S different than that of appfcant,indicate below Is property in question:Annually Assessed
eel Property ❑Annually Assessed
i .i1
Mobile Horne(IC 6-1.1-7)
Name of mortgagee or contract Belle � �/7�0, „'PPryry^//••//((yy--c77
Address of mortgagee or contract seller( of b and street city,state,and ZIP code -
other Name of assignee or oth owner or ••4 mortgage
Address of assignee(number and street city,state,and ZIP code) t fri0/ C / Ac- 0I'? do//9C
Does applicant own property in any other If yes,what county? , What Tadrgg Distric?O/yL-C,1, Has Eliia deduction been 7requested on property
county in Indana? for current year?
❑ ❑ No
Yes ❑ Yes ❑ No
I
Deduclior
me mint
COUNTY AUDROR I
20 l i-di it o 20 20 20 20
Signatu `( `! County I Date(month,day,year)
I/We certify under the penalty or pe.,..., __- -egoing 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 re(owners name) I Date(month,day,year)
resident address 'f appGrant(number and street say,state and ZIP e)
S gel4 t i s, �t, e,r 4A u1c,9cp0
Person authorized zed by duly executed Power of Attorney or by IC 6-1.1-1 -0.7 I Date(month,day,year)
Address of author ed person (number and street illy,stare.and ZIP code)