HomeMy WebLinkAboutMortgage_Casey (2) •
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
,;; FOR DEDUCTION FROM ASSESSED VALUATION
I:i State Farm 43709(R11/6-09)
Prescribed by Department of Lod Government Finance
•
File Mark
INSTRUCTIONS: TT
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is I I• • • —
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought dor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)mon s
before March 31 of each year the deduction is sought - . County Recorder
See reverse side for additional instructions and qualifications. NOV_ I
Applicant(owner or writs•b er-see ink.. r-veryeside) I / / r
Wm— _ _I�: . E I
•�suici Key number/ Id tiara ' Q � •• nnrw19l!!nlli Page number
1. t. - .11 t le- 0_01-�• -001 .749 aC•: cou Ta •uGI D
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contract indebtedness tmpaid as of Is the app6cait the sole
March 1,anent year March 1,current year date of application legal or equitable owner?
❑ Yes ❑ No
lino,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 ❑Annually Assessed
• Mobile Horne(IC&-1.1-7)
Name of mortgagee.0. ^^ nn / )/10./P 1�-�C
wsl `f— O
Address of mortgagee or contract seller(number and street,city,scat ZIP code)
Name of assignee or other owner or holder of mortgage U
Address of assignee(number and street,city.state,and LP code)
Does applicant own property in any other If yes,what county? - What Taring District? Has this deduction been requested on property .
county in Indiana? El yes ❑ No for current year?
❑ Yes ❑ No
COUNTY AUDITOR .
Deduction approved In the amount of
20 20 20_ 20 20 20 20
Signature Auditor s
uditor Canty Date(month,day,year)
1
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.
r>atu5 � reme) Date(month,day,year)
kio tpas�..s (9sa a " P -PrCuQL 2 • 4769(4E
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet,city,state,and LP code)