HomeMy WebLinkAboutMortgage_Lin ap STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count J sh r
FOR DEDUCTION FROM ASSESSED VALUATION 4 Ji__i I?t
' State Farm 43709(R11/6-09)
Prescribed by Department of Local Goverment Finance
INSTRUC77ONS: D�� ark��14 .
To be filed in person or mart with the County Auditor or County Recorder of the county where the property
Form mad with:
Pe by b ry ty P Pent is located.
Fling Dates: 1) Real Property:Must tile during the year for which the deduction is sought _r. ... ..
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)mon s BSO N C Zl sr
r
before March 31 of each year the deduction is sought
f _ N i • i°OR
See reverse side for additional instructions and qualifications.
Applicant( or contract b -see restrictions on reverse side)
Taxing District Key number/legal description Record number Page number
,. eV,- 14-tcg • 3a) -0(30. t-4 7 - Oa .. atet �F Sa37
Assessed of real property as of Mortgage I Contract indebtedness unpaid as of tMortgage I Contact indebtedness unpaid as of Is the applicant the sole
Mardi 1:current year March 1,current year date of application legal or equitable owner?
t.,,g DO-0 Upres ❑ No
If no,what Is his/her exact share of interest? '/ If owned with someone other than spouse,Indicate with whom
If name on record is different than that of applicant,Indicate below. Is the property in question:Annually Assessed
I
,�..•eat Property ❑AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
d mortgagee or contract seller
Address of mortgagee or contrail seller(number and sheet,city,state,and ZIP code) — —_ _
a� y ---
Name d assignee or other owner or holder of mortgage
Address of assignee(number and street call,state,and ZIP code) r3 - �/(� /\CO applicant own property in any other If yes,what county? - What' !✓� U (U I`/M`-')
county in Indiana?
❑ Yes CerNo No
COUNTY AUDITOR
Deduction approved in the amount of:
•
20 20 20 20 20 20 20
Signature of Canty Auditor ' 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-Signature . -mentioned •. ..-rty on date application is filed.
Signature(on es =k Date(month,day,year)
(cQ G L/tr7 Lo ry
Full ' t dap. u .- and street,lily,state,and ZIP code)
authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) .