HomeMy WebLinkAboutMortgage_Griswold (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
teal,` FOR DEDUCTION FROM ASSESSED VALUATION FILED
� .J State Form by aibn/609)
'`°�^.'fj''� Prescribed For l4 43709(R I of Low Gwemment Finame
File Mark
INSTRUCTIONS: !� q �f�1�f AA
b be filed in person or by mail with the County Auditor or County Recorder of thAM& pet4tmn4 property is located. Form Nerd
Filing Dates: 1) Real Property:Must Me during the year for which the deduction is sought County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:M file during th twe (12)months
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for additional instructions and qualifications. f; SON COUNTY AUDITOR
A,pfrmM(tm U+ .bu zees on revase�4n
Taxing Si.' '•' / ' Key number I description Recd tuber Page number• 6/(0-a.3-0/-400 cx� os�-oav oCol 3 Sass
•.....;•value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appfaant the sole
March 1,aamt year March 1,anen ygero 6 '^ date of application legal or equitable O
3 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 cruestra z Annually Assessed
❑Real Property ❑Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller / `al� /
Address of mortgagee or contract seller(numberr and street streeet.city.state,and lf�code) l//`Q-
IName of assignee or other owner or holder of mortgage — �V/
Dr a 11'L'r NO..C! — i-/ rte? What Taxing District? Has this deduction been requested on property .
(�\
^. for current year? El Yes El MO
Card NO. �l 1K COUNTY AUDITOR
___ I I 2u 20 20 20 20 .
Signature itor - • County Date(month, Y
`�'a-/ 7 .
1 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 contact buyer of the aforementioned property on date application is filed.
signature(owners Nil name) Date(month.day,year)
resident ( -p er
resderrt t(number and street.Gay,Math,and ZIP code)
/6670 1 Z e r"c,4 L.,,,,._ na..iii,c-itj T,., y76 i?
Person authorized by duty executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .