HomeMy WebLinkAboutMortgage_Riley (7) II,dy"wn , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
, FOR DEDUCTION FROM ASSESSED T..0
k
State Forth 43709(R11/609) L
Presmbed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. JUN 2 Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year tor-which,the deduction is sought.
Must be Red with the County Auditor or County Recorder of the county where the property is located ❑ County Auditor
on or before January 5 of the immediately succeeding cale t :r year.j rti El County Recorder
2) Mobile/Manufactured Homes not assessed as Real Prop-r, y, :4417111); he County Auditor of the
county where the property is located during the tler$g 6. : w . T: • -•/-w 21 oof each year the
deduction is sought. ITO
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
RILEY, STEVEN P
Taxing District • Key number/legal description Re 7
CSI 0111bI U 26-14-30-200-001.525-006 ( 1J1 JU(
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year Mal 1:alrenyyea& O,\ date of application legal or BquYesle❑owner?
No
If no,what is his/her exact share of interest? I IlJ\•/']l I1L^(_,{l If owned with someone other than spouse,indicate with whom IrLXf
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 contract seller
rnortmcu e, mass -
Address of mort a or tract setter_(number and street,city,state,and ZIP code)
44- E -V«Ai ni GL EVmsvii�.P I ki 411e6 _
Name of assignee or other ovsMr or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
•
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on properly
county in Indiana? for anent year?
❑ Yes I No ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
/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/contract buyer of the aforementioned property on date application is filed.
Signatur ens full name) Date(m nth,day, ear
Full residen address of applicant(number d street,city,state.and ZIP code)
9\11g g00114 11613 ia - (6-11-1 J Cth1 jN 41(AP°
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)