HomeMy WebLinkAboutMortgage_Akers f:a,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form by De (R71/Fr09) F' I E Its
Presrnbed by Departmem of Local Government Finance
INSTRUCTIONS:
To be filed in person or mail with the County Auditor or County Recorder of the county where the property F Nad r`
Pe by ty ty ty P PeNY is located. nnr
Filing Dates: f) Real Property:Must file during the year for which the deduction is sought. M/'I 2�Jnty 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. 0 Con er
See reverse side for additional instructions and qualifications.
1(owner or contract buyer-sea restr chi ns on /� GIBSUN (MUNI I AUDITOR
T - District Key number/legal description Record number Page number
,24241 -0 ? - ?'0/ - ° °O. o ?, / - o )w g a013 5z S$
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,current year date of application legal or equitable owner?
/) p i(01 El Yes ❑ No
If no,what is Ns/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is ddferent 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 contact seller S 3
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage T�
Address of assignee(number and sye t,city,slate,and ZIP code)
Drawer l,tO �/� —
s eer 1",l�-J /3 9 Pr TTJJ^^'
Does applicant own property in any other If yes,what county? What Taxing Die Card 1 Tr O
county in Indiana? . ••
❑ yes ❑ No
COUNTY AUDITOR _
Deduction approved in the amount at
20 20_ 20 20 20_ 20 20
Signature of County Auditor, ,, - �}7'---d
County Date(month,day,year)
n A
I/We certify under the penalty of perjury that the above and foregoing information is true and cored and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
\ - Signatne tuft name) Date(month,day,year)
�, g'
Full resident address of applicant(number and sheet,city,state,and ZIP code)
X3..V-7 F m t.f c_..,,ear- I2 - SY-- Y--2 67 o
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
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Address of authorized person (number and street.city,stale,and ZIP code) .