HomeMy WebLinkAboutMortgage_Roos ..T. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
aii FOR DEDUCTION FROM ASSESSED VALUATION
-7 Prete Fond b Department/6-09) 4����
Presaibed by Department rN Local Government Finance
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INSTRUCTIONS: lath.. A.
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is�q fed. J
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought ryfAl�' • County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)monthY 7
before March 31 of each year the deduction is sought i�4❑ County Recorder
See reverse side for-r--•itional instructions and qualifications.
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Appficanl(owner or•• t buyer-sea rave side) N:.QU
NT
Taxing District
/�• Key n �$ 3(0-description
00 -- Co Q. Sig- Oa y Y i PL 3
Assessed vatue of real property as of Mort9ape/Contract indebtedness unpaid as of 'I//�/Mortgage/Contract indebtedness unpaid as of Is the app�ant the 4
March 1,wrerrt year Mardi m c I date of application legal or equitable owner?Osti El Yes 0 N
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 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 contract seller C/)
Address of mortgagee or contract seller(number and saee4 cdy,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,ray //,/(/7�1
Does apprxara own property in any other D r a w c 1` N O./ Has this deduction been requested on property
county in Indiana? for current year?
❑ yes C /ir37 ❑ Yes ❑ No
Card NO. (/'G//
Deduction approved in the amount of
20 20 1 w 20 20 20
Signature of County Auditor County 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.
Sig re(o fur creme) Date(month,day,year)
F a of applicant(nu and scree ,state,�� -fauii-Lai if ) 63
Person authorized by duty exerted Power of Attorney or by IC 6-1.1-12-0.7 -• - • Date(month,day,year)
Address of authorized person (number and street,city,state.and ZIP code) .