HomeMy WebLinkAboutMortgage_Ferguson (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Year
._:-- _ �` y-
�rfl FOR DEDUCTION FROM ASSESSED VALUATION
Stare Farm 43709(R77/e-09)
Prescribed by Department of Local Government Finance
I e Mark
INSTRUCTIONS:
Form -. . .
To 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 Properly Must file during the year for which the deduction is sought , unty • ditto
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months ', y ��„ �;�,_ �
before March 31 of each year the deduction is sought GIBS
N • .
See reverse side for additional instructions and qualifications.
cam econ buyer- on reverse side)
T CY Old / a'�!o p707` 000T. yaa — Qo?k 7 number Page number
21 R-30
Assessed value of real popery as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract• :- .ress unpaid as of Is the apprIcant the sole
March 1,parent year March 1,current year date of r legal or equitable owner?
tics ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone otter than spouse,indicate with whom
If name on record is different than that of apptram,indicate below: ,IIss,tthhe property in question:Annually Assessed
�{/J Real Property ❑Annually Assessed
• 7 J� Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ( /Ig7 1 ,< _
Address of mortgagee or contract seller(number and street,city, X/e%,and/rZIP code) �d//�j'
Name of assignee or other owner or holder of mortgage 1 ) , / 1 /� /J �1
Address of assignee(number and street,city,state,and ZIP codee))( /// 7/f�K t/'"tr-d^eL�71 L/ /V/1%(/ -J[///�//n
Does applicant own property in any other If yes,what county? _ "What Tarim nissiv c
county in Indiana? ❑ Yes ❑ No I!�� � ) ❑ Yes 8 re oaSoN ❑ No
COI �p� D
Deduction approved in the amount of /-y - )
20 20 20 21 / 20
Signature of County Auditor • ay.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/contact buyer of the aforementioned property on date application is filed.
Sigrubrre/�,,.: n: Date(north,day,year)
I1 77/ 7
F — -t address o t(num r and street,city,state,and ZIP ) /
t -arson authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(monde,day.year)
Address of authorized person (number and street,city,state,and ZIP code) .