HomeMy WebLinkAboutMortgage_Pritchett STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year I
Are,_- '` FOR DEDUCTION FROM ASSESSED VALUATION TT ggg EL)
p-G.,�:• State Farm 43709(R11/6-09) ry L EL)
Prescribed by Department of Local Govemment Finance gq
INSTRUCTIONS: P _
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is 1oc 3
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months my Recorder
before March 31 of each year the deduction is sought.
jr0,4.
See reverse side for additional instructions and qualifications.
PARSON COUNTY AUDITOR
��t(owner or contract buyer-see restrictions on reverse side)
(L L 7'h PA 42- 6A tt
T District r Key number/legal desrnp. Record number Page number
AC0 - 1 7 - /01 - 2-0.1, - 00°. l7V- 0-1.1_ lY / 918
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the sppfuant the sole
March 1,anent year March 1,parent year date of appruation legal or equitable owner?
11 Co ❑ 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 different than that of appficant,trxticate 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 ]/y/,'�/
9\e"-C•1-
Address of mortgagee or contract seller(number and street,city,state.and ZIP code) �_r_�4.�/ _'/'�-t-�-
Name of assignee or other owner or holder of mortgage P�reFr�// "�ti /� Q /�jI/
Address of assignee(number and t,cat.stare.and 7 node)�r / • /" -r-���
Does apd own property in any other rM`—I If yes,what county? • What Taxing District? 3V I-)4 r yr 4iJ
county in Indiana? ❑ Yes ❑ No
N- 1958
COUNTY AUDfTOR
Deduction approved In the amount of
20 20 20 20 20 20 20
Signature of County Auditor. County Data(month,day,year)
AlliWLA I/We/We cee pena ty 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.
ante(owners long name) Date(month,day,year)ktrrr\
W resident of applicant(number and street,cS%state,and LP code)
tcsup ,Person authorized by duty executed Power of Niamey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and soeet city.state,and ZIP code)