HomeMy WebLinkAboutMortgage_Huff (3) a. STATEMENT OF MORTGAGE OR CON 1�II EB County Township I Year
FOR DEDUCTION FROM ASSESSED VAAS�JOtF�
Slide Fan, eg(R11/ )Prescrbed by Department of Local Government Fiance MA 01 2014
File Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the ..•n. ' X17 '. ocated. Form Ned with:
Filing Dates: 1) Real Property.Must file during the year for which the deduction I':r „DA AV County Auditor
2) Mobile/Manufactured Homes not assessed as Real Propet Al.:ii -M months
g the twelve(12)mons
before March 31 of each year the deduction is sought Gip County Recorder
See reverse side for additional instructions and qualifications.
Apgliwit(owner or contact rr-see restrictions on le e) /
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the apprrrartt the sole
March 1,artery year Ma 1ArrrentgroO date of application ❑ Yes ❑ oN
If no,what is his I her exact share of interest? `//1C//) �// If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Forme(IC 61.1-7)
Name of mortgagee or contract/Geller
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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,ray state,and ZIP Code) _
Does applicant own property in any other If yes,what county? • S on property
county in Indiana? ❑ yes ❑ No
I • es El No
LI
COON Drawer NO. .9P
Deductrrn approved in the amount of: - J
20 20 20 20 Card NO. +� t/SDI/
•
Signature of County Auditor • I 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/contract buyer of the aforementioned property on date application is filed.
,ler(o eft fuj�nl / Date(month,day,year)
Full resident address addraddres,_ ooffaapp_Ur q 4Lmber and street,thy,state,-an/d ZZIIPP code)
/ r}�G Al/ a OLCC- Sr '/7Lio
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street dry.state,and ZIP code) .