HomeMy WebLinkAboutMortgage_Hogmire E.}.:. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
UFOR DEDUCTION FROM ASSESSED VALUATION
-uf t, Stale Farm da709(R11/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: r
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To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. ! : - 1
Filing Dates: 1) Real Properly Must file during the year for which the deduction is sought. =I untyjwditor.
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 - I • County Recorder
See revers- side for additional instructions and qualifications. /qt ,,y�O
Appfoan 1. .r or contract buyer- -,- on reverse side) • /' nn//
ate Xldly
Ta rtI ,ii,• Key number!fi•al description pr 'SUN umber
Y AoS �I
�lo �/! _o/ _ `toy - � oY. 3coo - oJ�E� /o9/Yao uolroR
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applUnl the sole
March 1,current year March 1,current year date of application legal or equitable owner?
57.01oo0 ❑ Yes 0 N
K no,what is his!her exact share of interest? It owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate bebw^ Is the property in question:Annually Assessed
❑Real Property ❑AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of nee(number and`sl�eet airy,slate,and ZIP code) _ /
Does applicant own rty in any other If yes,what county? , What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ No for current year?
❑ Yes ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved m the amount of
20 20 20 20 20 20 20
Signs re of County Auditor vizAnw`eik., County Date(month,day,year)
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 I contract buyer of the aforementioned property on date application is filed.
Signature(owner's mA pane) Date(month,day,year)rein
CII resident address of ap^J t(nu and street city,state,and ZIP wde
alf. Uklc htc\t 3- LOA- 11-11 VC i rce r\ �N y 7 In - 0
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street my state,and ZIP code) .