HomeMy WebLinkAboutMortgage_Speedy (4) t ate. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
s. 'f State Farm 43709(RU/S-OS)
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Prescribed by Department of Local Government Finance
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INSTRUCTIONS: .d re: 1
To be filed in person or by mail with the County Auditor or County Recorder of the county where the F�g I 1[e: 2 2013
properly is located. IL--Jr
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought
I 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 - ❑a 'LIMY _et jU
See reverse side for additional instructions and quart cations. t c N COUNTY AUDITOR
Appdirant( `or con r-sae re on rewe side) — G BO
1PC` 4 A . . ) I
V i Record Page number
Tam i -tg l 3 it ten )/1 3997
Assessed value of real property as of Mort gage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as Is the appalant the sole
Moth 1.current year March t year date of application legal or equitable owner?
5511 1 ❑ yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate vAth whom
It name on record is different than that of applcant.indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
I Mobile Flame(IC 6-1.1-7)
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Name of mortgagee or contact seller (tJ/3
Address of mortgagee or contract seller(number and street city.state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage - /�/�/(/\ `11 _
Address of assignee(number and street thy,state,and ZIF 1 r 6 ` 3
Drawer NO..., ..
Does applicant own property in any other If Y• _ `(��I -is this deduction been requested on property .
county in Indiana? ❑ Yes ❑ No Card NO. .. 1� onset ?
❑ Yes ❑ No
i
Deduction approved in the amount of.
20 20 20 20 — 20 I20 20
Signature of County Auditor County 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
Amer I contact buyer of the aforementioned property on date application is filed.
..re(owner's tae name) Date(month,day,year)
e �� Leant( n)ber a streeC state,and LP code)
_ leant ea f,_ TI✓ ?/-'nu/a-.. yTilol
P A 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 sheet city,state,and ZIP code) _