HomeMy WebLinkAboutMortgage_Burr (3) a eta.
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coup '_N Q ty f rj+:r
FOR DEDUCTION FROM ASSESSED VALUATION . , I
jt, State Fenn 43709(R11/6-09)
Prescribed by Department of Local Government Finance
I WWM4rk 603 INSTRUCTIONS:
To be h7ed in person or by mail with the County Auditor or County Recorder of the county where the property is located F Ned
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Filing Dates: i) Real Property Must file during the year for which the deduction is sought I tin :%OTr!1!!cer.�,�rR�1o�eT(�
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)monthsGjBc ON `�l frxyQ QR
before March 31 of each year the deduction is sought
See reverse for additional instructions and qualifications.
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Taxi v-._- Key bee/ desoi Record number Pa a tuber
f /"r o -1d/ /0% . 69-00?P olo�a Y4'dO
value dreal property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract teh, es4 unpaid as of Is the applant the sole
Maw 1,current year March 1,current year dam of application / J legal or equitable awneN7
❑ 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 is afferent than that of applicant.indicate below-. Is the[vvvprpP��Prr�bOb°°°perty in question:Annually Assessed
mai Property ❑Mobile Horn esed
I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ki. a
Address of mortgagee or contract seder(number and street.city.stare.and ZIP code)
Name of assignee or other owner or holder of mortgage
•
Address of assignee(number and street,city,state,and ZIP code) O
Z Oa° /d I
Does applicant own property in any other If yes,what county? • What Taxing District? Has this'deduction been requested on property
county in Indiana? ❑ Yes El No for current year? ❑ Yes
❑ No
I
COUNTY AUDITOR I
Deduction approved N the amount of.
20 20 20 20 20 20 20
Signature of County Auditor County -._________I Date(month.day,year)
(�
I I We certify under the penalty of perjury that the above and foregoing information is true (3uR2
ear , RA'7 mUif49-J-
owner I contract buyer of the aforementioned property on date application is filed. v4NeAl
1 Sigrawre(owner's full came) .
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.i,,, .•_..- c2-38.5o —
Fufl If.ent add - of.pplicant number and street city,state,and ZIP code)
I` ll- i i. —
. •'•._•by duty executed Power of A omey or by IC 6-1.1-12-0.7
Address of authorized person (number and sine;city,state,and ZIP code)