HomeMy WebLinkAboutMortgage_Bockhold STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
CoiFOR DEDUCTION FROM ASSESSED VALUATION
State Forth 43709(R11/609) {g��'r'
Prescribed by Department of Local Government Finance '^ 1
INSTRUCTIONS: .
Form lfilledd with:
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is IocaMAR 2 - 2015
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. l J County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought - •- County Recorder
See reverse side for additional instructions and qualifications. GIBS
/� ^�/ ��,,/ ON COUNTY Auul FOR
Applicant(owner co contract buye ee(esbns on. ?arse-1) .//1`�r27"�"ou/t
Ta istrict s Key number/legal description Record Page number
j -1."-corn. . a !o- !Z -02 • ,toy- pica . 0/.3 -°a / a a q
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the app€ant the w
Mardi 1,arrant year March 1,arrent year date of application legal or equitable owner?
❑ Yes ❑ 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
❑Real Property ❑AnnuaftyAssessed
/ Mobile Home(IC 6-1.1-7)
Name of mortgagelor onuact seller � 1•
111 L' t,�Gn/ ?/2,,1-C.b
Address of mortgagee or contract seller(number and street,city,stars,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,end ZIP code) I ' tt..F-r 2
Does applicant own property in any other If yes,what county? • What Taxi
county in Indiana? ❑ Yes
❑ No )44 _ !\ No
COUNTY AUDROI ckv9CI
Deduction approved in the amount of. -
20 20 20 20 20 20 20
Sigreu�ae �CountyAUdCOr • I County Date(month,day,year)
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 aforementioned property on date application is filed.
Slg rq(owners frArame) Date(month.da.
eresident add of applicant Sslate
f -3E n/ee t ?rr iior I/` { CA20 .
Person authorized by duty executed
Power of Attomey 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) .