HomeMy WebLinkAboutMortgage_Mathis a. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count; Township Year
FOR DEDUCTION/6-09)FROM ASSESSED VALUATION
''.�x,.,R�' State Forth 43709(R11 � Imp
Prescribed by Department of Loral Government Finance 1-4 LE
File Mark
INSTRUCTIONS: M I ?r.:filed .41t .
7o be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought 9 County Auditor
2)Mobil e/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months ,t • .r
before March 31 of each year the deductions sought .Jmgi�;my Recorder
See reverse side for additional instructions and qualifications. {, �� GIBSON e . • - . 1 1 OR
or contract buyer-see revere side)) ^ "`r
T t5bict c Key numbarl legal desolation Record number Page
62(0-1a-o8 -- /03 oo j. a�9_o � 8 010 5 d 8
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contrail'indebtedness unpaid as of Is the eppfuant the sole
March 1;current year March 1,current year date of a&pficsgon legal or equitable owner?
000 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone oiler than cprvse,indicate with whom
If name on record is 6tferent than that of applicant.Indicate below Is the property in question:Annualy Assessed
❑Real Property El Annually Assessed
- Mobile Home QC 6-1.1-7)
Name of mortgagee or contract seller /` 3 _ _ _ - _ ___ _ _
Address of mortgagee or contract seller(number and meet city,state,and ZIP code) it -/�(�/(/�/( /�^
Name of assignee or other owner or holder of mortgage Drawer NO c- R .(/,�f(
�of assignee(number and street city,state,and ZIP code ��l X Y•J
. Yr ,ucJ 8 - a-/o , Aft A c Card NO. (JU (?l\
Does applicant own property in any other If yes,what county? • What Taxing District?
county in Indiana? .
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of - .
20 20 20 20 20 20 20
Sig .tyArr . County Date(month,day,year)
I I We certify under 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 aforemeennttiioo/nedd property on date application is filed.
Signature( is ^ame) /J / !G„K[i0 Date(month,day,year)
Full resident appli annttt((\(nnumberand street,aiy state,and ZIP e),
C- fda a 5247/e r_32-ree f larice1Itn, /n/ `/7670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Data(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .