HomeMy WebLinkAboutMortgage_Abell (2) i "•. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Township Year E r. ?'.. �,
FOR DEDUCTION FROM ASSESSED VALUATION
State Form ertm/6-09)
Prescribed by Deferment of Local Government Finance
File Mark
INSTRUCTIONS: JU Fr s rftri:
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought I County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(1 2)months y.
before March 31 of each year the deduction is sought wCn7l��aunty Recorder
See reverse side for additionsl instructions and qualifications.
GIBSONC•• • • • • ■ . -
Appbcant fyRims orcontact buy/ see restrictions on reverse side)
Q _t
T D'
Key number/legal E can Record number Page number
al - 0 -` 0L8 - 3oo - cc" y..57-oz7 ? 0 3.0--C
Assessed value of real��as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year Mantic 1,cement year data of application legal or equitable owner?
S a/ 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 different 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 contact seller
1-F(
Address of mortgagee or contract setter(number and street,coy state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Add of assignee(number and stree city,state,and 2
Pr 5 et) .)- -1 -i0
Does applicant own property in any other 11
mi 1
nty in Indiana? ❑ No 1
❑ Yes U
I 0 o
Deduction approved in the amount of: T-- \ O Cll
20 20 2 V c.-- 1
_ t
9igre of 7 I\1) k0 C
I/We certify under the penally of perjury that tit C6
owner I contract buyer of the aforementioned p
Signature(owne/s hrt name, ,, -
fiCLC, 4. G'
FWI resident address of applicant(numbers street,ctly,state,and e) r
�2tg3 N. S-ia�e &�, la5 1t oki��n! �t"Ilolala
Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,oty,state.and LP code) .