HomeMy WebLinkAboutMortgage_Ellis F.a e.. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
State Form eg(R111 6-69)
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Prescribed by Department of Lod Government Finance
INSTRUCTIONS: F �d
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. II{.I g '1014
Filing Dates: 1) Real Property.Must fie during the year for which the deduction is sought - Tt County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property.Must file during the twelve(12)months O
before March 31 of each year the deduction is sought • •u r•. = •er
See reverse side for additional instructions and qualifications. - �1JT1lIr
Applicant(owner ormnbad coyer-see restrictions on reverse side) GtDSON COUNTY AUDITOR
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Taxing District Key number/legal desmp' Record number Page number
A - ii - ( - 300 - oat/. 35s- oaf 5 ,33 -xoILi
Assessed :�real....:.1 as ol Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1:• -,year March 1,current year date of application legal or equitable owner?
If no,what is his/her exact share of interest? If owned with someone other indicate ❑ Yes ❑ No
than spouse,in ate with Alum
If name on record is NSerent than that of applicant,indicate bebw. Is the property in question Annually Assessed
❑Real Property ❑Annual/Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seer. Po, € i )1A-C, LY CYr^I-a.G(;
Address of mortgagee or contract seller(number 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 applicant own property in any other If yes,what county? • What T _____.y
county in Indiana? ❑ Yes No Drawer NO �Q/ .
COUNTY AUDIT r�
Deduction approved in the amount of • Card )N O. . Sa3 •.
20 20 20 20 f /V O 1 ••• _
1 iQQd , �Jd
Signature of County Auditor • �`y ' •"`J' County Date(month,day,year)
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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 l contract buyer of the aforementioned property on date application is filed. .
natu / Date(nmrdh,day,year)
#1/f/2,y
t%F en of..,.• t( , berand street,oly,state,and ZIP code) _ /
9A9Y s St to c�.. Y7c- �_5
authorzed by duly executed Power of Atmmey or by IC 6-1.1-12-0.7 Date(north,day,year)
Address of authorized person (number and street,city state,and ZIP code) .