HomeMy WebLinkAboutMortgage_Miley (7) . STATEMENT OF MORTGAGE OR caw' FOR DEDUCTIION FROM ASSESSED VA UATION INDEBTEDNESS County Township f Year
State Fond 93709(R11/6-09) a�IL�
Prescribed by Depanmertl of LnW Government Frtarlca F LE
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. i 14
Fling Dates: 1) Real Property Must file during the year for which the deduction is sought. 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
See reverse side for additional instructions and qualifications. "�4 �Sf'
nISQON COUNTY n�'DfTOa •
Appfioan or contract buyer mstittons 9lpverse.tide)
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`—I/ /Y�7`/an—QJ Pr
TaAng�J,� Key number/legal description Record number Page number
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appIrant the sole
Man%1,anent year March 1,current year data of application legal or equitable owne&
g CZ( 00d El Yes 0 N
If no,what is his/her exact share of interest? If owned with someone other than spouse.indicate with whom
If name on record's different than that of applicant.Indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /I .
Address of mortgagee or contract seller(number and street,city,statty a n
Name of assignee or other owner or holder of mortgage Lt) C
Address of assignee(number and street,shy.state,and LP code) l'--- C c J
•
Kj JA
Does applicant core property in any other If yes,what coo V
county in Indiana? ❑ Yes El No
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0
(.- 1 Detlu9a approved in the amount o1 z
v
20 20 zo (� 1n'�. O
Signature of only Auditor, - I N r�
I/We certify under the penalty of perjury ury that the above and E v
owner 1 contract buyer of the aforementioned property on da-
owners hA name 1n."",c�>,Mal X " mc� - ( b� I -� l
Full resident address of t number street.cagy,state,and ZIP code)
falgti ki ( 50 Si R- 6r-an met r i4 47/c Lig
Person authorized by duty 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) .