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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' : FOR DEDUCTION FROM ASSESSED VALUATION
t State farts by Department artm I t of L
Prescribed by Deparmrent of Lod Government Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. N I i hl 0.113
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 I I ��,r• '--• •err
See reverse side for additional instructions and qualifications. (;I R S Q N G nUN T�' P UD 7T08
Appfcan . r or tractpyyer-gee restrictions on reverse ) I
T District /U/Cl `^-f/- Key number/ I desaiptionn tuber Page number
a�rrQ,� a 1a - /ovoo. oa3. 37 /-v a 3999
Assessed value al real property&of Mortgage/Conoacindebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the apprcant the sole
Mash 1,cement year March 1,current .J/ OD data of apparition t legal ore equitable
If no,what is his/her exact share of interest? If owned with someone other than spouse,Indicate with whom
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If name on record is different than that of applicant indicate below: I Is the property in question:Annually Assessed
• — -----Cl.emragv Assessed__
Name of mortgagee or contract seber (/ c--(.L / -"""'' r 82-ace, Q 1-7r si 0
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Address of mortgagee or contract seller(number and street city,stares and ZIP code) ' , II Nay 6
Name of assignee or other owner or holder of mortgage /1/43 - 3c �9
Add of assignee(number and street,ray,state,and ZIP code) II
Pr f sc / b - a -16 /3, SyS ,- c
Does applicant own property in any other .If yes,what county? • What Taring District? Has thiv deduction been requested on property -
county in Indiana? El yes El No for current year? ❑ Yes
❑ No
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COUNTY AUDITOR I
Deduction approved in the amount of:
20 20 20 20 20 120 20
Signs a of County Auditor, County I Date(month,day,year)
I I We certify under the penalty of of per above and foregoing information is true and correct and that the i pplicant is a resident of Indiana and
er i contract buyer of the aforementioned property on date application is filed.
`,f ,fa .(owners fu0 cram,- 1 Date(sonde,day,year)
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ruff .-..;•- t add t(number apstme4 cti))state.art:coda)Dss..4.Lk-
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n authored by duty eseat of Attorney or by IC 6.1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and meet city,state,and ZIP code)
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