HomeMy WebLinkAboutMortgage_Chestnut STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FI �)
FOR DEDUCTION FROM ASSESSED VALUATION gg
't State Form d by De (R11/6-09) g
' P111111 2 1 4 1
Prescribed try Depamnen of Local Government Finance
INSTRUCTIONS: �o�n�d�tmt
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located. t U t7 G 1 LQ 1 4
Filing 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 deductions sought A ❑ L •u,r -"• •er
See reverse side for additional instructions and qualifications. }� f;IRSf1N COUNTY AIInITOR
Apparent 6 �resos m^ reverse side) Y7 1
T X027&/legal description _ 0,3 - o 0 0, s 9 - o a-8 o Page�C7
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March 1,amen year date vk application Legal or equitable owner?
010r 000 ❑ Yes El No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom 1
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(IC 6-1.1-7)
Name of mortgagee or contract seller
-
Address of mortgagee or contract seller(number and street,city,state.and ZIP code) O' _ _
Y
Name of assignee or other owner or holder of mortgage c
DraIcel. )NO '.ab1.'`,.. ..:':..
Address o assignee(number and ray,s1a ,and ZIP code)
/761.4.4-t y/ Pi //a PT 1670
Does applicant own property in any other If yes,what county? 'What Taxing I - "`t 1'u 1`r O. ••.••
county in Indiana? •. .••
❑ Yes ❑ No
a0,000.00,
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 I 20_ 20 20 . 20 20_ -
signature a/�_ �ZP1 County Date(month.der.rear)
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 I contract buyer of the aforementioned property on date application is filed.
Signature(owners MI name) Date(month,day.year)
(Full resident addreba bf applicant(number and street,aiy,state.and ZIP code)
`{\rk U13e I W vRt om S i , 8 R t n)ce.TDa fl y7 07O
Person authored by duly executed Power of Attorney or by IC 6-1.1-12-0.7 / Date(month,day.year)
-i
Address of authorized person (number and street,dry,state,and ZIP code) .