HomeMy WebLinkAboutMortgage_Mayer (2) r•fa,,._, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION T�
', State Forte 43709 Department r t of L �'M2
Prescribed by 709(R11/ of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the re N
Filing Dates: 1) Real Property Must file dining the ty ty p located. M/ `"'4
rg 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 - ,A � 1 `/ r r,•• •er
See reverse side for additional instructions and qualifications. i "
GIRCON COUNTY AUDITOR
Appf rant(owner or contract buyer-see restrictions on reverse.tide)
Taxi •Oict '
str Kay number/legal descrip' Record member Pa V
um
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the app8 nt the sole
Math 1,armor year Math 1,crarent year date of application legal o equtable owner?
3a , 550 ❑ Yes 0 N
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
It name on record is different than that of appf rant,indicate below: Is the property in Question:Annually Assessed
❑Real Property ❑Annually Assessed
• Mobile Norse(IC 6-1.1-7)
Name of mortgagee or contract seller
513
Address of mortgagee or contract seller(number treet city,state.and ZIP code) _ _
Name of assignee or other owner or holder of mortgage •
Address of ree(numbpsarq street.tiry,state,and ZIP e) �O �� Drawer N O......
•Dees ap �m own property in any other If yes,what county? • What Taxing Card \ `� )
county in Indiana? ❑ Yes NO
❑ No ..U(... .... ..... 10
COUNTY AUDITOR _
Deduction approved In the amount of:
20_ 20 20 20 20 20 20
Signs of County Auditor County Date(month,day,year)
V
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
owner/contract buyer of the aforementioned property on date application is filed.
owners ha name) } Date(month.day.Year)
X TIT . _ • PPP-•• sa4I737,Thust•6. 42.asocili IN 47 439
Perron. ' by. esewte4 _ . r.A. o by IC 61.1-12 .7 Date(rtprW,day,yea0
Address of authorized person (number and sheet city,state,and ZIP code)