HomeMy WebLinkAboutMortgage_Hary 41" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
siSA FOR DEDUCTION FROM ASSESSED VALUATION
.,' 1' State Fannn370g(R11/6-09)
Presmbed by Department of Laml Government Finance
File Mark
INSTRUCTIONS: .
7o be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located • a !
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought } •.1.2
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months '1 1�
before March 31 of each year the deduction is sought • County Recorder
•
See reverse side for additional instructions and qualifications. MAR 30 [U15
'
MAR
Appfuant(• or contract buyer Lm
Taxing D. .-..I nmtber/ desoiption/ • q /� Record•triertT. . ._
/ �{O ' 11�I4a •D ' ttQ. 8 I -oa 1 IRSONCOUNTYAUDITOR
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage I Contact indeb&dr,ass unpaid as of Is the applicant the sole
March 1,assent year Mardc 1,arrenl yrar date of aP legal or equitable owner?
(}l(�/{//1J��//✓���/�) ❑ Yes ❑ No
t no,what's his/her exact share of interest? If owned with someo e�than spouse,indicate with wtErn
If name on record is different than that of applicant,Indicate below Is the property in question:Annually Assessed
❑Real Property ❑ArvwallyAssessed
Mobde Home(IC 6-1.1-7)
Name of mortgagee or contract seller 51 3
•Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and— J / eTPd 4
Does applicant own property in any other I �– aRgI c'/!1(' r L s this deduction been requested on ply
county in Indiana? ❑ ND 0Q-/iyy current year? ❑ Yes ❑ No
❑ Yes (�I r
Deduction approved in the amount of. • /%6 age)
20 20 20 _ 1 to 1 20 20
•
Signature of County Auditor - County Date(month,day,year)
I 1 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/contract buyer of the entioned property on date appitcatfort is filed. .
Signature(owner's M name Date(month,day,year)
FW r¢sid s a pfran rw rand str9p;a , te, P code) /'a /t /�r ry Li 76 7�
Person authorized by duly executed Power of Attorney or by IC 6-1-1-12-0-7 '[Gf•R�) 1/ {(/'�,_\r'Ly_( Date(monN,daY.year)
Address of authorized person (number and street,city,state,and LP code) .