HomeMy WebLinkAboutMortgage_Leary STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
b—_I FOR DEDUCTION FROM ASSESSED VALUATION
:I`- J State Pond by De arum/6-09) ��
—:�'' Presrnbed by OepaNnenl of L.oml Government Finance �"�
`J9✓I. File Mark
INSTRUCTIONS: \ Form fay with:
To be filed in person or by mail with the County Auditor or County Recorder of the county whe e pm petty is locate Q
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought. \\� County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the lwel (t2)months
before March 31 of each year the deduction is sought - 1j • County Recorder
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See reverse side for additional instructions and qua��yy. catkins. _n �� AVON
AppOOanl(owner tray buyer ee n:sJirrtions cu+ prise side) COV
ix(J on pN
CigS
Taring District Key number/legal desatption RacaN P number
��- cl-of - coo mil. o ?10? 1 0S► 68
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year Mann 1 nt Yearu� date of appf ation legal or equitable owner?
tilt ❑ Yes ❑ No
If no,what is his I her exact share of interest? l 9 H owned with someone other than spouse.Indicate with whom
If name on record is different than that of applaud.indicate ^f_1W(`\` /f Is the property in question:Annually Assessed
K- ❑12aa1 PpoPem ❑Mmue I-lom e(IC 6
-o'"t ll. Annlia Hose ss Cr1.1-7)
Name at mortgagee or contract seller
Address of mortgagee or contract seller(number a"--^• ^th,vats.and ZIP code)
Name of assignee or other owner or holder of ma L C At1 Cie v^r/
Address of assignee(number and street,dry,Val
,v/ I` �If-�'')7Q.•
in any other / ( _)I `" Has this deduction been requested on property
Does applicant Iin hit a?n property y
county in Indiana? for anent year?
❑ Yes ❑ h ❑ Yes ❑ No
'-
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor • County Date(month,day,year)
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/contract buyer of the aforementioned property on date application is filed.
• (owner's fig name) Date(month,day,year)
tl rside t address of a�t(numstreet city,stale,and ZIP code)
r (ISM) Cite n ;n5 won f4 / Ou�ensv;I(e .1';,1 417665
Person authorized by duty exew�elP�we ear 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) .