HomeMy WebLinkAboutMortgage_Hawkins 1 . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.i _=' FOR DEDUCTION FROM ASSESSED VALUATION
TPrate form
Prescribed by De partm ent of Local Government Finance
FILED
INSTRUCTIONS: o�+�p
Tb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is locaMM 1 /111A
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. `n T County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the lweNe(12)months
before March 31 of each year the deduction is sought I 3 A -• ty Recorder
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See reverse side for additional instructions and qualifications.
GIRSON rOUNTY AUDITOR
App///frt��tanl or contact buyer l reverse side(,.( N • '
49g Dt/ Key number/legal description /N� Record number Page number
a& -ia -a - ioi - 00,3 . ito / - o �� got y X508
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mania 1,current year March 1,amen year ], date of application legal or equitable owner?
3
7 4 3 a ❑ 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 Is the property in question:Annual!),Assessed•
❑Real Property ❑Annually Assessed
Mobile Barre(IC 6-1.1-7)
Name of mortgagee or contract seller
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mortgagee of tgagee or contract seller(number and street coy,state,and ZIP code)
Name of assignee a assignee or other owner or holdec(rr oof mortgage
Pddresa/ / (number IL) / O -scatA and ZIP
/!�code) /l` -) l;/ 4 C .-
what Does applicant own property in any other If yes, at county? • [What Taring District? _.I Has this deduction been reeuested on oropertv
county in Indiana? ❑ Yes ❑ No
Ambulance Billing Services, Inc.� .
Ikdacaon apprwed'ut the amount of-.
COUNI • 4 a 911 Maryland Ave. • Elkhart, IN 46516
)'�_I 1-877-293-3535 • www.ambulancebill.us ::pi
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Signature of County Auditor . •
I W certify under the penally of perjury that the above and foregoing inf
owner I contract buyer of the aforementioned property on date application 4/ 0(41° .(i0 5 0
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W resident address of appfi an um and street olx state,and ZIP code)
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Person authorized by Q9y executed Power of ALn,ey or by IC 6-1.1-12-0.7
Address of authorized person (number and street,city,state,and ZIP code) •