HomeMy WebLinkAboutMortgage_Sandusky (2) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
� FOR DEDUCTION FROM ASSESSED VALUATION 141 I�
77'' Slate Foam 43709(R11 16-09)
•
Presoibed by Department of Local Government Finance
File Mark
INSTRUCTIONS: .
JAN 5 F. z.•with
To be filed in person or by mad with the CountyAuditor or County Recorder of the county where the properly is boated
Fling Dates: 1) Real Property:Must file during the year for which the deduction is sought • County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12) •( s . r r Art County Recorder
before March 31 of each year the deductions sought - —.jirlt)j�r ty
See reverse side for additional instructions and qualifications. GIBSON COON • • to •R
Applicant(owner or contract buyer-see restriaigps on reverse side)
a //legal description T / – 30( –
00/. 6 / - 0a ?6 PI J`
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1:aanent year Mardi 1,current year date of application legal or equitable owner?
(1-5, 00O ❑Yes 0 N
If no,what is his I her exact share of interest? If owned with someone other than^iru'e,indicate with whom
If name on record is different than that of apparent,bill to he ow Is the property in question:Annually Assessed
❑Real Property ❑AnnualyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contact seller(number and street,arty,state,and ZIP code)
Name of assignee or other owner or holder of mortgage �/1���/�/� /`�
I'1
Add of assignee(numbpr number and street,city:state,and ZIP coley / '' Q 15 —I-4a
OiC4`^.ir7/Ri �,��,( � /7 nom. 111
Does applicant own property in any other ✓ If yes, /what ro C7 tY
county in Indiana? /� h❑ Yes ❑ No _ _ - _ - &�_/{(`_—I No
Deduction approved in the amount of: •
q5 / 066)
20 20 20
Sig o(cermty Ar#itpr
I/We certify under the penalty of perjury that the above am - and
owner/contract buyer of the aforementioned property on d:
tSignature}nw aI name Date(month,day,year)
ull resident address of appticastre ary,state,and ZIP code)
$30 aIa:aeAve 9rif.cet-on TN 417670
Person authorized by duly executed Power of Attorney or by IC fs1.1-12-0.7 Date(month,day,)ear)
Address of authorized person (number and street city,state,and ZIP code)