HomeMy WebLinkAboutMortgage_Brock STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS 1 County Township 1 Year
4.iii Ss FOR DEDUCTION FROM ASSESSED VALUATION
'tt1 State Form ( 09)
Prescribed by D epartment of Local Government Finance
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INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Farm n1
Ring Dates: 1) Real Property Must file during the year for which the deduction is sought [)� my AZag
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 M County Recorder
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See reverse side for additional instructions and qualifications. 717Pni?lfr,
Applicant buyer-see ' on reve ) r I,1' I b • ' • NTY AAUU�DIITO'
Taxing District ,___,d�300- .V�/ sr-^DI/Ial_j�/.'.C/—%�/.`+ Record 14_bra Page 3013
Assessed value of real property as of Mortgage/Contract' tedness unpaid as of a/.ItI Mortgage/Conceit indebtedness tmpaid as of Is the appfran!/t the sole
March 1,arms year Marsh 1,cement year (� g }pate of application legal or equitable owner?
A {{///V//777///VVVtt,{{{///JIIY'yJJ) ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant.Indicate below. Is the property in question:Annually Assessed
❑Real Property ❑AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
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Address of mortgagee or contract seller(number and street city,staff.and ZIP code)
Name of assignee or other owner or holder of ma-gage
Address of assignee(n � (�'�//'�)
Does applicant own pr Drawer ``r O.... ''... // Tang District? Has this deduction been requested on pmry
county in Indiana? ••.. ... xi for current year? ❑ Yes ❑ No
Card •ro. .....(3 3
(TOR
Deduction approved i
•
•
20_ 20 1 I cv _ 20 20 20_ .
1
Signore of County Auditor County Date(month,day,year)
11 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.
t. . a name) Date(moral,day.year)
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Full .•s --of apptran5jnumber tap• -.t cry, and ZIP code n
Persian authorized by duly executed Power of Aaomey 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) .