HomeMy WebLinkAboutMortgage_Slinker X14.. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
, `e„` FOR DEDUCTION FROM ASSESSED VALUATION
..s gars Fool 49709(RU/6-09)
Presmbed by Department of Int Government Finance
File Mark
INSTRUCTIONS: �g�1 F««rmm �--1 •
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is local ` ,YL'--'
Fdmg Dates: 1) Real Property Must file during the year for which the deduction is sought Or Manly ditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months pH ty
before March 31 of each year the deduction is sought - C CT 97 G l tf a Recorder
-
See reverse side for additional instructions and qualifications.
Appr ( or contract buyer-see restrictions on reverse side) •
Taxing District Key number//legal desorption GI f 1d A�4 NT vela 'SR
�
oz (p r ( 7 - O/ _ YOB/ - ADO. QO60.L ,20tw 3 /077
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
March 1;when year Manic 1,current year date of application legal or equitable owner?
53 QOD 0 Yes 0 No
If no,what U his/her exact share of interest? If owned with someone other tan spouse,Indicate with whom
If name on rend is ddferent than that of applicant.indicate below Is the property in question:Annually Assessed
❑Real Property ❑AnnuallyAssessed
Mobile Horne(IC 6-1.1-7)
Name of mortgagee or contract
C E! •'�/�//
Address of mortgagee or contact seller(number and steel 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 applicant own property in any other If yes,what county? • What Taxing Di /�//y'
county in Indiana? V
❑ Yes ❑ No Drawer NO No
COUNTY AUDITOR (5�j/,7?
Deduction approved in the amount of: Card NO. (XX i / •
20 20 _ 20 20 _
Signature of County Auditor.. r,!_7/ s- ' County Date(month,day,)ear)
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/contact buyer of the aforementioned property on date apprtcation is filed.
kSigraW,/%�'/forwners NO name) n� �:�///�/ / Date(month,day. tar)
(srirThM t//�// � -/- andst4
enter of applicant and stye , ,state, 2la
5-oz , cSicm-a, cP/S aQ', V/%e 2)v 4-!766
Person authored by duly executed Power of Attorney or by IC 6-1.1-12-0. Date(month,day,year)
Address of authorized person (number and street,dry,state,and ZIP code) •