HomeMy WebLinkAboutMortgage_Thompson STATEMENT OF MORTGAGE OR CONTRACT I N SS NE Y unty Township Year
FOR DEDUCTION FROM ASSESSED VALUATI �J
State ram 43709(Ru I 6-09)
Presmbed q Department of Local Government Franca OCT 6 ZQ 1 File Mark
INSTRUCTIONS: .
To be filed in person or by mail with the County Auditor or County Recorder of the county whb the p ted. Form fled with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is snug ) County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Re rg9 J s 81
before March 31 of each year the deduction s sought (i l tSJ '��� County Recorder
See reverse side for additional instructions and qualifications.
Ap• (owner or contact er-see restrictions on rse side)
T. r�j'. '��I/ Key number/ al description ar� Record manber Page number!
Assessed rabie of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1;anent year March 1,current year date of application legal or equitable owner?
753000 Dyes ❑ No
It no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is rLtterent than that of applicant,Indicate below: Is the property in question:AnnualyAssessed
❑Real Property ❑Annually Assessed
-
Mobile Home(IC 6-1.1-7)
_
e)of mot. ..ee or contract seller
i \ //
Address of mortgagee or contract erynther and street.city.state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does app cant own property in any other If yes,what county? • What Taring District? Has this deduction been requested an property
county m Indiana? for current year?
❑ No
❑ yes ❑ yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County motor • County Date(month,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 contract buyer of the aforementioned property on date application is filed. .
(o fns name e�) Date(month,day,year)
N``
Full resident address eppGcanl(number a street,a1Jy,state,and ZIP code) •
� apt( w. 1—ouJST— 1— guru Rrcvlc' h —L0 2176 V7
Person authored by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of autharaed person (number and street,city,state,and ZIP code) '