HomeMy WebLinkAboutMortgage_Baker (2) c :) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
7: State Form by Department rem/6-09)
-VILE,
Prescribed by Deparbnem of Local Government Finance
INSTRUCTIONS: I
b be fled in person or by mail with the County Auditor or County Recoder of the county where the property is located.' D E 3
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. 9 County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must Me during the twelve(12)months,
before March 31 of each year the deduction is sought t ecorder
See reverse side for additional instructions and qualifications.
•• (owner or contract buyer-see restrictions GIB SON COUNTY AUDITOR
T.: .District ' , /X / djy esrnPOO^ Record number Page number
�, / aCg — a3- llo - 0100- o0A - YBx-o .y i -2o /3 Yos7
karma-.Hof real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
year Mardi 1,content year data of apprication legal or equitable owner?
J co o o o ❑ Yes ❑ No
if rn,what is his titer exact share of interest? If owned with someone other than spore,i dicete with whom
If name on record is different than that of applicant-indicate below. Is the progeny in question:Annually Assessed
❑Real.Property ❑AnnuallyAssessed
l Mobile Home(IC 6-1.1-7)
Name of mortgagee a contrail seller - V
w
Address of mortgagee or contract seller(number and street city,state.and ZIP co de /
Name of assignee or other owner or holder of mortgage C�-
Address gnee(nu and ste city,state,and ZIP code) •
ccti /el- Drawer NO
Does applicant arm pro any other If yes,what county? • What Taring Di � ..
county in Indian? C '
Yes ❑ No Calif NO ..1'057 0
COUNTY AUDITOR 4 150400..'e•'•-.
Deduction approved in the amount of:
20 20 20 20 20 20 20
'
Signature of County Auditor J - County
a Data(month,day,year)
I I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the dppii ant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed. i
"\ Signature(owners AS name)4 - — r/�s'o<qa /] m 111- /,�( Datei((mond,day,year)
1/Fy1I 7 laddress of amEtt(nuus \�(7// 7,7dP/i�state,,a�`''Z_I&ve) I�l ( l ✓`)1 1 L N I, 17b .7 9
r Person authorized l by drAy executed Power of AAtmmey or M w 6i1.1-12-0.7 —try' , '•1t/�t Data(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) .
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