HomeMy WebLinkAboutMortgage_Kirchoff (2) . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township 1 Year
FOR DEDUCTION FROM ASSESSED VALUATION � '
P:s.y State Form by Department rum nt of L
Presaibed try Depamrtem of Loral Government Finance
INSTRUCTIONS: pad,
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is IocatedJ U N tt r%I11
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought L[3 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 JN/)i El Recorder
See reverse side for additional instructions and qualifications. GIRRON M
Apra t( y n re COU 1TY .�UD}TOR
Ta � ber/legal desmp' Record number Page number
e0 - IS- ay -/0/- 00.2 . 045 - 01r LoIY ,2 587
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the apoft ant the sole
March 1,anent year March 1,wrrent year date of appucatun0�) O \ legal or equitable owner?
— U 0 Yes ❑ No
If no,what is his/her exact share of inte rest? if owned with someone other than spouse,indicate with whom
If name on record is afferent than that of applicant cdieate below Is the property in question:Annually Assessed
❑Rea)Property ❑Annually Assessed
Mobile Fwro nr• -')
Name of mortgagee or contract seller
5/3 - •
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) NO !/�//�'/I r"�/{j,/./ —
Name of assignee or other owner or holder of mortgage Drawer NO.• "O� •••• —
Address nee(number and sheet,city,state,and Z code)
—J}� .Z 5A to PT Card NO 9375)47.-.
Does applicant own in any other�,v If yes,what county? . What Taxing Dshia
county in Indiana? ❑ Yee ❑ No •.0 -
COUNTY AUDITOR
Deduction approved in the amount at.
20 20 20 20 20 20 20
Sigma a _ ^v• County Data(month,day,year)
/"
I I We certify under the penally 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.
Nit Sig (owner3 Loll nerve '�. Date(month,day,year)
a
X Full en� t(n sheet city,state,and ZIP code) •
2163 -vouch' NNC-61 'F. DR.. FOR-TBRANCN12N 'n yg
Person auunrized by duly executed Power of Attorney or by IC 61.1-12-117 Date(month,day,year)
Address of authorized person (number and sheet,crty state,and ZIP code) .