HomeMy WebLinkAboutMortgage_Young (5) STATEMENT OF MORTGAGE OR CONTRACT I Brt5 Val ' Court Township Year
Fw i..,. r41 FOR DEDUCTION FROM ASSESSED VALUATI
State fcrtn 4a7f19(R71/6-09) ^1�_-
Prescribed by Department of load Government Finance 2
p,N 3 File Mark
INSTRUCTIONS: ,di
,��r OR Form fled with:
To be filed in person or by mad with the County Auditor or County Recorder of the county where pit•-yj? r - .;; T
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought. ' Nj`( . County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during I - •(12)months
before March 31 of each year the deduction is sought. 609° ❑ County Recorder
See reverse side ifional instructions and qualifications.
Applicant(owner buyer see rons on raver)
�"}'ng District Key number/legal desalt Record number Pag number
C arena+ nit-,-j -zo-<ion n /` o 9 00 (o (i�() / 3 6/aJ`
Assessed value real property as of Mortgage/Contract indebtedness unpaid as of rMoit9a9e/Contract indebtedness unpaid as of b the applicant the sole
March 1,curet year Martin 1,aurent year ate of application legal or equitable owner?
/ 'dt 179 c ❑ Yes ❑ 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: rIss the property in question:Mnualy Assessed
veal Property ❑Amwagy Assessed
Mobile Home QC 61.1-7)
Name of mortgagery�r contact seller
Address of mortgagee or contract seller(number and street,city,sate,and ZIP code)
Name of assignee or other owner or holder of mortgage
-
Address of assignee(number and street cif):slate,and ZIP code) _ _— ---
Dces applicant own property in any other If yes,what county? - .What �'
county in Indiana? ❑ Yes ❑ No �0 I ] No
Dla\\'CI NO...................
COUNTY AUDIT' I ///1I �//�)
Deduction approved in the amount of - { V 4l/`., ......•
Cald NO. .• V••
20 20 20 20 _- 20
Signature of County Auditor County Date(month,day,year)
I 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
comer I contract buyer of the aforementioned property on date application is filed.
$J\i]o��jnature(owners hi name) ) )/ `O Date(month,day,year)
Full resident address of applicant(number and street, . e,and )
—41'6'231 r 20o S OQjCfou-rd C.A. to 41(.ocoo
authorized by duly executed Power of Attorney or by IC 1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,sate,and ZIP code) .