HomeMy WebLinkAboutMortgage_Mason (7) ,- STATEMENT OF MORTGAGE OR CONTRACT IND= ;• :is I SS �j''f Township Year
��' :9: FOR DEDUCTION FROM ASSESSED VALUATIO li i �FIIJ/ 7
• _ " State Form 93709(R11/6-09)
Prescribed by Departure"of Local Government Finance DEC 1
2 14 File Mark
INSTRUCTIONS:
Form filed with
To be filed in person or by mad with the County Auditor or County Recorder of the county wh s' e pro_ jar--- -..
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought. Ir,It -I' mll1. 16 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:MuB gcift9(, •' 1, :fro R County Recorder
before March 31 of each year the deduction is sought tY
See reverse side for ad.;'vnal instructions and qualifications.
Appfrmt(owrnrco.. 0 see - :• - >.. �1�1X .��.{./1 ��/ �VN'`�
r� I I 1
T Key numbed al description Record number Page number
��.r o-19-19—a03-Lb1. a(0s--�T6 - go /Lc 3zc/
Assessed value of real property as of Mortgage/Contract unpaid as of Mortgage I Contract indebtedness Webtedness unpaid as of Is the apptrant the sole
Mani =Lint
Manic 1: nt year March 1.current Fro 5 data of application legal or equitable owner?
U( • Dyes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record's different than that of applicant Indicate below- Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or contract serer ///�'''.��� /y
Address of mortgagee or contract seller(number and streeL �a) \/
Drawer NrO......... icode).COUNTY What Taxbg Districs? s dedear been requested on property
for current ❑ Yes ❑ No
Card 1i\'O. .... . AUDITOR
Deduction approved in the am unt at:20 20 20 20 20 20 20
SiSS. Ccna:ry car Q County Date(rnaW,day.year)
1/We certify under the penalty of perjury that the above aegoing information is true and correct and that the applicant is a resident of Indiana and
er I contract buyer of the aforementioned property on pplication is filed.
tura(owners full name L,/5(_Date(nronN,day,yea,F resident address of appliicant(number and street obt sate,and
- r//o9E '795- S
Person authorized by dry executed Power of Attmrey or by IC 6-1.1-12-0.7 Date(nnnrn,day:year)
Address of authorized person (number and street dty.stare.and LP code) .