HomeMy WebLinkAboutMortgage_Doerner STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
S 5. FOR DEDUCTION FROM ASSESSED VALUATION
:' 4' State Farm 3709(Rll/6-0 of prescribed try 4 Oepatbnent d)Lad Goverment Finarnce
File Mark
INSTRUCTIONS:
FM, '•2w; • 1 '
To be fired in person or by mail with the County Auditor or County Recorder of the county where the property is boated.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. D County uditw
2) Mobile/Manufactured Homes not assessed as Real Property.Must file during the twelve(12)months q
before March 31 of each year the deduction is sought - emrder
See reverse side for additional instructions and qualifications. GIBS• • • • • ' a
Applicant(owner or contract buyer-see resainarns on reverse side) •
`� Sa-(t c'-re-a/ta- 7C
Ta ' District Key number/legal description Record number Page number
al('- 010 - /e - 9O0 - 003. /4V- oil 1 3 5 e Sr
Assessed valued proper,.as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the apt the sole
Marti 1,current year March 1,current year date of application legal or equitable owner?
230 000 ❑ Yes ❑ No
If no,what S his/her exact share of interest? If owned with someone other thdo 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 ❑A nuaMAssessed
P � Mobile Home(IC 6-1.1-7)Name d mortgagee or contact seller k- I
Address of mortgagee or attract sea r(number and streak city, te.and ZIP code)
Name of assignee or other owner or holder of mortgage __ ___I_
Address of assignee(number and street state,and ZIP code) L 01'4 � / 1704 C.Lt
PT H &J 55 /t-/ -9 s'4L �ll,n p Oi�
• Does applicant ova property in any other If yes,what county? What Taxing District? TC.-�EA r4-
county in Indiana?
❑ Yes ❑ No
iq j,85
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20_ 20 20 _ 20 20_ .
Signature of r County - Data(mvh,day,year)/ (
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 contrail buyer of the aforementioned property on date application is filed.
\ Signature wrier''s h f`/IA 1 Date(month,day,year)
ou resident address of a t(number a street state,and ZIP code)
lx11c5 €goo NJ brar\USco I 0 il1t94c
Person authored by they smarted Power of Attorney or by IC 6-1.1-12-0.7 Date(ninth,day,year)
Address of authorized person (number and steel,city,state,and ZIP code) .