HomeMy WebLinkAboutMortgage_Brown (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
4:
FOR DEDUCTION FROM ASSESSED VALUATION
2 State Farm 43709(RU
neat of F
Prescribed sed by Department 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 _F wt.
Filing Dates: 1) Real Property Must Me during the sought �� located
g year for which the deduction is so ht. D ,n�y Auditor
2) Mob de/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months t--t
before March 31 of each year the deduction is sought - �J Co er
See reverse side for additional instructions and qualifications. C IBSO N COUNTY AUDITOR
AWntnitowner or contract buyer-Ks restrictions on rse side) /ey
rg Key number/legal desrnp' Record number Page number
;t a6,-/8- 36,- .3 co - ooi 97a -oa.ti 01-0 / 3 (a1 (
.
--_.value of real property as of Mortgage l Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the apprmard the sole
Marts 1,current year March 1.amen year date of application legal or equitable owner?
) 760 OOO ID Yes El NO
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of appicant,Indicate below: is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
- Mobile Home(IC 6-1.1-7)
Name of mortgagee or comma seller • `so
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Addy of assignee(number and street, . , te,and ZIP code)
. X t 8
Does applicant own property in any other If yes, county? - What Taring District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for t yew ❑ Yes ❑ No
COUNTY AUDITOR ---- -_I_
Deduction approved in the amount of
Drawer NO....c�Q1
20 20 20 20 20_ ••• •• .......
Signature of County Auctar ' " �a��/�� - minty Card No. ...I. l! 7/./
I/We the penalty of perjury that the above and foregoing information is We and coned and that the app i.!-"_fir coo. ;:°2
owner/con.-. •uyer of the aforementioned property on date application is filed.
}/'Signal re owns tame) ' R / Data(month,day,year)
resident....._—of apprt ant(number and sbee4 city,state,and ZIP code)
//Y/ , c-1, 12.4.4‘,-i- r2✓r✓ hint kner 1'a r/)c.?5'
Person a • . '.!.by duly executed Power of Attorney or by IC 6-1.1-124.7 / Date(month,day,year)
Address of authaized person (number end street,city.state,and ZIP code) .
- - • I