HomeMy WebLinkAboutMortgage_Lacy (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Y/Fro
siiki FOR DEDUCTION FROM ASSESSED VALUATION
1;, State Fonn 93709(R11/6-09)
'''? Presmbed by Department of Local Government Finance
File a
INSTRUCTIONS: f� f
7o be fled in person or by mad with the County Auditor or County Recorder of the county where the property is located. Fonn�tl�ithf V ZO'd
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought. • County Audit&
2) Mobile/Manufactured Homes not assessed as Real Property.Must hie during the twelve(12)months
before March 31 of each year the deduction is sought - FA Gou 1. R--R . •on,' vi it See re�versseside for additiionnal instructions and q fications. GIB ON COON �f•�/ a, �rsary AUDR
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of I Contract indebtedness unpaid as of Is the applicant the sole
March 1:area year March 1,current year date legal or equitable owner?
(M6 - ❑ Yes ❑ No
If no,what Is his/her exact share of interest? If owned with someo/ie other than spouse,indicate with whom
If name on record is afferent than that of applicant,Indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Hone(IC 6-1.1-7)
Name of mortgagee or contract seller '
Ar
Address of mortgagee or contract seller(nu •-I,city,state,and Zl•coda)
Name of assignee or other owner or holder• mortgage
Address of /3-05-// /oa/ye
assignee(number and sheet,a01 state,and ZIP code)
Does applicant own property in any other If yes,what county? • What Taxing District? Has this deduction been requested on property
county in Indiana? El yes ❑ No for current year? ❑ yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount oft
20_ 20 20 20 20 20 20
Signature of County Auditor - County Date(month,day,year)
I I We certify under the penalty of perjury that the above and foregoing information is true and cortect and that the applicant is a resident of Indiana and
owner I.• _. buyer of the aforementioned property on date application is filed.
r sigratu :rs hA .me) // Date(month,day,year)
F rm of a t(num randdssheeet rn L e
x (a Q ��_PI LOS -0747
Person authorized by udy executed Power of Attorney or by IC 1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet city,state.and ZIP code)