HomeMy WebLinkAboutMortgage_Backes f_a. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION �_-
.: t-'� State Forth 43709 609)
Presmbed by (Kilt/
Department of Loral Government Fuurce
I File Mark
INSTRUCTIONS: '
be filed in person or by mail with the County Auditor or County Recorder of the county w th orated Forth coed with:
b
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sough S) County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the hve,(vet[1$1 minty Recorder
before March 31 of each year the deduction is sought - Mal G
See reverse side for additional instructions and qualifications.
Ap t(owner or cont buyer-sae(�5st`�ns on reverse side)
O'a-2 I 1 1 00-C fl, wc011NTY AUDITOR
District Key number/legal description 3 C,)BSU Record number Page number
ng Assessed value of real as of Mortgage/Contract indebtedness unpaid Mortgage/C tract indebtetedness unpaidas o f�Is the app the sole
Manic 1,anent year March 1,current year ...A date of appicatm legal or equitable owner?
(0g� l • ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than w K.P.Indicate with whom
If name on record is different than that of applicant.Indicate bed' Is the property in question:Annually Assessed
I (teal Property ❑Arm flyAssessed
r� Mobile Horn(IC 6-1.1-7)
Name of mortgagee or contract seller,SSt F b
Address of mortgagee or contract seller(number er(numb and,�,street city:state,and ZIP code) 11 ��.�j
Name of assignee or other owner or holder of mortgage - cJt4 Lc L - lJ-f°l
No.a.o.t5........
Address of assignee(number and street city,stare,and ZIP code) D) 'aW Cl (
Does applicant awn property in any other If yes,what cour .•59C .......... seen requested on property
county n Indiana? ❑ No N O - _^ 00/ ❑ Yes
❑ Yes Card �(11j ❑ No
I
Deduction approved in the amount of. • -
20 20 20 20 20 20 20
Signature of County Auditor 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.
Signal's ndm t /� LZ �� �j ''7 Date(morah,day,year) `
Full resident 9 9 g of applicant(number R,L5 state. LP code)
0,\ _ k ! Lp f O _ I _
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-01 1�Y!1 T Date(month,day,year)
Address of authorized person (number and street city,state.and ZIP code) .