HomeMy WebLinkAboutMortgage_Frederick STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
��`'n—;' FOR DEDUCTION FROM ASSESSED VALUATION
State Form 497e9 Department ft-0g)
Prescribed by Oartrn of Local Government Finance
FIL, E File Mark
INSTRUCTIONS: Form filed wth:
To be filed in person or by mail with the County Auditor or County Recorder of the county*pp tteproor s located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sough't. L u I'f County Auditor
2)Mobile/Manufactured Homes not assessed as Real Properly Must file during the twelve(12)months FLI}
before March 31 of each year the deduction is sought County Recorder
See reverse side for a dditronal inst(uciions and qualifications.
AppGUnt(owreror see G13S^,N COUNTY AiIDITUtt
T=: ..D'•.-..
Key number d ton Recoil rnber Page number
1a• ''a �11� iF oc(o- 36- (flu.- 000.38a'oq koi4 acts
• ...value of real property as of Mortgage/ n-indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,and year March 1,—45i,9r' date of wide:aton legal or equitable owner?
C�Q� El
ID 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 different than that of applicant indicate below: Is the property in question:Annually Assessed
�� /] ❑Real Property ❑Annually 1.1-7)
- Mobile Home(IC Name of mortgagee or contract seller j • /��,TI n/ /
Address of mortgagee or contract seller(number and street city,state and ZIP code)/�AIJ .
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city.state,and ZIP code)
Does applicant awn property in any other If yes,what county? . What Taxing District? Has this deduction been requested an property
county in Indiana? ❑ Yes ❑ No
for current year' ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved In the amount of
20 20 20 20 20 20 20
Signe unty Auditor k t County Date(month,day /
1-
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
owner/contract buyer of the afore eat property on date application is filed.
SEreto ,(. -- ,V^y',) Date(month,daY.year)
ull•— .-nt ress pPriant um r and Street a]y,state,amyZ'P catlaj / i�( 3 �y
I11i tI€ -e, r 71 ll�S c Vf �Y� `/r
authorized by duly executed Power of Money or by IC 61.1-12-0.7 Date(month,day.)ear)
Address of authorized person (number and meet city state,and ZIP code) .