HomeMy WebLinkAboutMortgage_Sisk (5) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r�.` FOR DEDUCTION FROM ASSESSED VALUATION
State Farm 43709(R11/6-09)
Presorted by Department of Local Government Finance
File Mark
INSTRUCTIONS:
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.
Fifing Dates: 1) Real Property:Must file during the year for which the deduction is sought Cp
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months ?•� M b
before March 31 of each year the deduction is sought • b rJ�LrdJ�'
I
See reverse side for additional instructions and qualifications.
Applicant(owner or contact buyer- restictfns reverse side) MAY / 2014
an-L4_4 ) Ye 4 4� �-e c a' , c� 2.0 0 33,1/
. AI r I Key num legal desaiptlon Record age
A 1 (o- /a -o7 - 3o3 -0o% S95 -0 c?
• value of real property as of Mortgage/Contract Gtdebtedness unpaid as of Mortgage I Contact indebtednesWASSIAC ION
March 1,arrent year March 1,anent year date of appficatb n legal or egr
30, 500 Eves 0 N
If no,what's his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on recut is different than that of applicant,Indicate below Is the
property in question:Annually Assessed
p Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 5/3
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP�code /�//�,/�/,
Does applkant awn property in any other a` If Tres,what county? • NTat Taxing Dstdi "" ••••••••••• _
county in Indiana?
El yes El No /�
COUNTY AUDITOR
Card NO
l
Deduction approved in the amount of: •
20 20 20_ 20 20 20 20 20
Signs County Audimn CCounty Date(month,day,year)
/
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 I contract buyer of the aforementioned property on date application is filed.
XSignature owner's fun name) Date(month,day,year)
�('��� � r�d)
Full resident aGdr�itrrapprrant(number and stoat city,state,and ZIP code)
At-
)1/4/Full
Tar' S. 1 4( .S.- Pr„'tirpram, Ti, 4c 767A
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 end street city,state.and ZIP coda)