HomeMy WebLinkAboutMortgage_Whitehead (2) ems, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County �Ttwnshp 1 r
FOR DEDUCTION FROM ASSESSED VALUATION Y p �-i
State Form by Department .�J I
Prescribed by Depamnem of Local Government Finance
INSTRUCTIONS: APR I1 2014
Form filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought.
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2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months lI�►r. �t
before March31 of each year the deduction is sought GIBSoN *U r41t: • 1 i r�VR
See reverse side for additional instructions and qualificatio s.
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T. : r'.. . Key tuber l legal desoiption Record number Page
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h; -.vd4<of real property as of Mortgage/Contraa indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
r.: . 1.riled year March 1,current year date of application legal or equitable owner?
407. an ❑ Yes El No
If no,what Is his/her exact share of interest? It owned with someone other than spouse,indicate with whom
If name on record's different than that of applicant,indicate below. Is property in question:Mnuaay Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /�� y / r t .L4 � n
Address of mortgagee or contract seller l\(n /umber`9_aannd('stree_ and zip code)
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Name of assignee or other owner or holder of mortgage
Address of assignee(number end street city,state,and ZIP code)
Does applicant cam property in any other If yes,what county? • I What Taxing District? I Ras this deduction been requested on property
county in Indiana?
❑ Yes ❑ No (�O/9 ❑ No
COUNTY Drawer NO ,2
Deduction approved in the amount of: f �j
20 20 20 zo Card NO. ...../.9�2 ?It
Signature of Canty Auditor
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 hm name) )`') // /J Date(month,day,year)
1\., ef/ll he /.0 ia-C-C
I Full en of applicant(number and street orb,state,and ZIP code)
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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 clef state,and ZIP code) .