HomeMy WebLinkAboutMortgage_Brandebourg (2) .a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS county ip 1ar6
F
� FOR DEDUCTION FROM ASSESSED VALUATION
State fbnn 43709(R71 DEDUCTION)
FROM
by Department of local Go'.emment Finance
INSTRUCTIONS: Fil 17 2014
Form filed with:
To be filed in person or by mad with the County Auditor or County Recorder of the county when:the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought ///���/�
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months IM ITOR
before March 31 of each year the deduction is sought - -OINK'
C)SS
See reverse side for additional instructions and qualifications.
AppGmntecor C011inaef buyer-see restrictions on verse side) ct
Taring oistrrl r IKey number/legal d fLw number
rd number Page numb
to', alai - 05 8-bbkz, - 0 co. Vol - bt7 1I 534`1'
Assessed value oreal property as of =arm/e/Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant the sole
Math 1,current year Marrh 9,wrtent year date of appfrawn Iegal°requitable owner?
9 .1 Jbat I21 Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than cpnrw,indicate with wham
If name on mcord is different than that of applicant Indicate below. 1 Is the pew' 'i:Annually Assessed
bre .inualty Assessed
'tle Honiee(IC 6-1.1-7)
Name r110 ee or con Ct seller
Address of mortgagee or contract vnnr(number and street,coy,state.and ZIP code) (�Q. c-6
Name of assignee or other owner or holder et mortgage / ���,\D `- t 0 I ,mss
Address of assignee(number and street,city,state,and ZIP code) V t,!1 \\ r�
county ap licant o? any other t���"" If yes,what county? \O f deduction been requested on property
❑ Yes l7=Frvo J �� ❑ Yes No
\\ COUNTY AUDn
Deduction approved in the amount of: •
20 20 20 20 20 20 20
Signature of County Auditor • 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.
ii I a hd/name) ' I Date(math.day,year)
• S.-.A. A. i .4 A..1__ .IL A
Hof ap t(num•-ra street,al}; e,and P code)(P(�a r I. ( LS 14( 1 Cl NE ' /.rOb( icl (17.0 c'p-
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street,city.state,and ZIP code) .