HomeMy WebLinkAboutMortgage_McEllhiney �": STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County I Township I Year I
;',a,:4::,
, FOR DEDUCTION FROM ASSESSED VALUATION
FILED
tic pal
,`B-��_.� State Form 45705(R11/5-0S)
••, Prescribed by Depa;.meat of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. W",t e•'-! • -
Firing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed with the County Auditor or County Recorder of the county where the property is located Count Au•'+ r
on or before January 5 of the immediately succeeding calendar year. �I. .41ry"p Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of ,e., 1
county where the property is located during the twelve(12)months before March 31 of each year !!tea . •
deduction is sought.
See reverse side for additional instructions and qualifications.
Ap li nt( wnee or contract MctoTttictions on reverse side)
Taxing District Key number/leg description 1 ,- 3 Record number Pace number
et-Uitaz I i3 ao ion 000-oso 005 P Sao hls l ao ►�l I x597
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/ nsac: debtedness unpaid as of Is the applicant the sole
March 1.current year March 1,current year date ahplia legal or equiable owner?
�Ip) Yes ❑ No
I If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
I If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobde Home(IC 6-1.1-7)
Name of mortgagee contract er 1 .
Address of mortgagee orbnuact seller(cumber and street.city,save.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.city,state,and ZIP code)
Does applicant own property in any other I If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? ttt�ttrnrnrnrnrnn for current year?
❑ yes tpNo ❑ yes 0 N
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20_ 20 20 20
Signature of County Auditor I 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.
5_ig(tature(owners full name) C I Dare(m��;n yger)
F O resident addres orff applicant(nu b r andlstreet, • tale,and ZIP code) l/%_ C(J7 rT/
yOa era's 5 - -'9 * (sW) /N 4'7t04q
Person authorized by duly executed Power /f Attorney or by IC 6-1.1-12-6.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)