HomeMy WebLinkAboutMortgage_Parker (10) ►,t:ak,` STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township [ Year
�i FOR DEDUCTION FROM ASSESSED VALUATION TT���II
• State Form by Department(R11 I t of L I�i-11B4NBI1(b
Prescribed by Department of Local Government Finance
INSTRUCT7ONS: �d
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. kw Fby 7 ta
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought fu County 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 /)r un er
See reverse side for additional instructions and qualifications. q l B SON COUNTY AUDITOR
AppecaLn ( or contract buyer-see on reverse aide)
77- V � ' �
Tashi; atria Key number/legal description Record number Page number
a(o -17- 11 - 100 - o0-3, SY7 - o A./ 01008 3rh
Assessed of real as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1, year March 1.current year date of application legal or equitable owner?
ll/ 000 ❑ Yes ❑ No
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 ❑AnnuafyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller c/3 i1 _—
Address of mortgagee or contract seller(number and`street.city,state,and ZIP code) - —
Name of assignee or other owner or holder of mortgage
Drawer iNO... d7, c�v�
er
Address of assignee(number and street my.state,and DP code) ....
1
Does applicant own property in any other If yes,what county? • What. Ca 1-47 NO. Si
county in Indiana? CO My
❑ yes ❑ No ...... ........... 3 No
COUNTY AUD .
Deduction approved in the amount of .
20 20 20 20 20 20 20
Signet(ra tQr ' • County Data(month,day,year)
I I We certify under the penaltyoff 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 wnerS fug rgmOo)J Date(month,day,Year)
c_5— /'/41 .
A/Fun resident address of applicant(number and street,My,,state,and ZIP code)
77111' W !i 00 5
Person authorized by duly executed Power of Aitomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,oily,state,and ZIP code)