HomeMy WebLinkAboutMortgage_McNeely �. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE a. . Township Year
ct -= ;- FOR DEDUCTION FROM ASSESSED VALUATION-F I
state Formby Department of)
Presrnbed by Department of Local Government Finance
File
INSTRUCTIONS: T 2°14 File Mark
Oki 1 �� Form filed with
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is Iota .
Fling Dates: 1) Real Property:Must file during the year for which the deduction is sought. A County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the s
before March 31 of each year the deductions sought N COUNTY AUDITO ❑ County Recorder
See reverse side for additional instructions and qualifications. GIBSO
Ap (owner arco buyer $e r° an,p �/ I�0
axt C)•`/ Key number/Slegal`description Record number Page number
a6- /ad 7-3d acb3. boa _ flare /t, //°
valueAssessevalue of real properly as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the pppf rt the sole
March 1;anent year Mardi 1,fu � date of appficatnn legal or equitable awn&
{/( ❑ 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 read is different than that of apptcant,Indicate below: 1 Is the property in question:Annually Assessed
teal Property❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee o^r contract seller n/y (11_C/ y nc\pA 0 0
Address of ort contract seller(number and street,city,state,and ZIP ' / 1l� /uCl-tip /Y Ski' L.Y L
Name of assignee or other owner or holder of mortgage
/Lea (41D1
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any other If yes,what county? oeerh requested on property
county in Indiana? ❑ Yes ❑ No I i ❑ yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount at -
20 20 20 20 20 20 20_
Signature of County Auditor ' County Dale(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.
g per's/ry name}///li f Xer Date(month,,/%,/
u resident address of applicant(number and street,thy, te,and ZIP code)
> lair? != etA.P.k ST 1R1 Aire - on 2 t 117‘ 7 0
Person authorized by duly 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)