HomeMy WebLinkAboutMortgage_Reel (2) , 1- . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION FIT ,State Fenn 43709
De artm/e-og) 1 RA-1 .
Prescribed by Department of local Gmemrtcnt Finance
File Mark
INSTRUCTIONS: 1,1i p,,, I
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Ring Dates: 1) Real Property 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 twelve(12)months
before March 31 of each year the deduction is sought L II,�1. Gs -ecord e
See reverse side for additional instructions and qualifications. GIBSO ` • • • • • •
Applicant( •mar or contract buyer-see res7trs on re side)
Taxing District - Key number/ description Record number Page numbs
p Ala -/8-06 -- 303- 00o. 730 - oaL 2oIti 31to 9
Assessed re of real property as of Mortgage/Contrea Irdehtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appOpnt the sole
March 1,amt year Mardi 1,current year data of appfmation legal or equitable owner?
/$D O0 D ❑ Yes ❑ No
If no,what is his/her exact share of interest? M owned with someone other thin 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 Home(1C 6-1.1-7)
Name of mortgagee or contract seller ,
Address of mortgagee or contract seller(number and street,cM.state,and ZIP coda)
Name of assignee or other owner or holder of mortgage - /'� // __—I
Address of ea( mbar an t.city,state, Pcode) 7 D/ all:el- No._.c /7 ..,
Does applicant own property N any other If yes,what county? What Taxing D
county in Indira? Card i'\r O. ...'. . .
❑ Yes ❑ No V Y
COUNTY AUDITOR
Deduction approved in the amount oft
20 20 20 20 20 20 _ 20_ .
Signature� h�
/ofCou,n,ty��Aud�itor County 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 I contract buyer of the aforementioned property on date application is filed.
Signaaxre(o. erFht name) Data(north,day,year)
Full resident a number and street,try,state,and ZIP code)
30 - ,ac4 /a/ 0/11/FN,SIO//e /A
• 9?& c
Person authorized by duly executed Power o ey or by IC 6-1.1-12-0.7 Data(month,day,year)
Address of author zed person (number and street ray,state,and ZIP code) .