HomeMy WebLinkAboutMortgage_Boxell -Vi�iYa`� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
i FOR DEDUCTION FROM ASSESSED VALUATION
'_'• j= State d 43709 Department Prescribed by Oepartmenl of Local Government Finance
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INSTRUCTIONS: prtn
To be fled in person or by mail with the County Auditor or County Recorder of the county where the property f9'"Topatgl.b ZC f`f filed wt
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 deduction is sought - /)r �) County Romer
See reverse side for additional instructions and qualifications. JNI`l'',r�r.'.',"' i-
Applicant(owner car er- resaictiterne side)e) r ^!!AITV AI)ry1TnR
number/legal description Record number Page number
aT to -06-3 boo oov i 819 oa, acid ;3 37
Assessed value of real as of I Mortgage/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sa
March 1;current year I March 1,anent year date of application legal or equitable owner?
o tray ❑ 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 afferent than that of applicant,Indicate below: Is the property in question:AnnuafyAssessed
❑Real Property ❑Annually Assessed
• - Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract Belle 7 —
Address of mortgagee or contract seller(number and street,city,state,and ZIP cote) —
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,stare,and ZIP code) Card ^ .....
Does applicant own property in any other If yes,what county? • what T �•a rd 1r o. , l..`//�/x).6 ,per,
aunty in Indiana? ❑ Yes ❑ No - .•••••...•....... ❑ No
COUNTY AUDITOR
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. .
SignaWre (ut named, Date day,year)
f)C as- /V
Fut resident �,,(•.+�. t •-r and street cal:sta tend ZIP code) 'I,,,,, __ r-I 74
Person authorized by duly executed Power o ••.• - or by IC 5-1.1-12-0.7 Date(nordh,day,)ear)
Address of authorized person (number and skeet,dt%state,and ZIP code) •