HomeMy WebLinkAboutMortgage_Kendle Paul D STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS anintarniltra
ilt
:am FOR DEDUCTION FROM ASSESSED VALUATION
r•"' t Preto Form by De art__nt 6-09)
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Prescribed try Department of Local Government Palatka � � s
INSTRUCTIONS: File Ma
b be filed in person or mail with the County Auditor or County Recorder of the county where the rota
Pe by N ic h property is located. �.Imy.it,'
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought ff::�ppSO N C 0 T 1'X 1 QpL
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)
mo71NS �V K
before March 37 of each year the deduction is sought • County Recorder
See reverse side for additional instructions and qualifications.
Appfimnt(owner or contract p L. s bp\y� r-seen restrictions __verse city) r
T>pst irl ` "y number/legal description Record number Pe numtw
As��Imo_ a(e- 3- (9 .4 bb-n 0. 341 s- 00'4 I n13 39 `i (A
MarYt 1,atsrerrt Y� property as of �Mo Mortgage t yindebtedness� 1 unpaid as of date Mortgage
f apprrootnn Indebtedness unpaid as of legal or equitable a the sole
owner?
µ�7' 1 I b in I }-W Yes ❑ No
If no,what's his/her exact share of interest? If owned with someone other than spouse indi ate with whom T
If name on record is different than that of applicant.indicate below- 11��tj_h�e property in question:Annually Assessed
Oh; Proms' ❑Annually Assessed
I Mobile Home(IC 6-1.1-7)
Name or seller I
Address of mortgagee r contract surer(number and street city,state,and ZIP code) I
Name of assignee or other owner or holder of mortgage
I I
Address at assignee(number and street city,state,and ZIP code) I
Drawer NO..JO.(.,
Taxing Does applicant own property in any other If yes,what county? . What Tang District? Q
county in Indiana? p �
❑ Yes No Card NO. I I
COUNTY AUDITOR Q�,II L I71 1 (`,v l i
Deduction approved in the amount at � b
20 20 20 20 20 20 20
Signature of County Auditor County 1 Date( .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.
Signature full name) Date(month,day,year)
�W(}p CLVi v
ent address of applxant(number and street city,slate,and ZIP code)
alas S. 650E t-ra rm.( se-0 T. nr 4 7b 41
n authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 ' Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) _