HomeMy WebLinkAboutMortgage_Strickland (3) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Maw, ip 1 I.
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._ ;, FOR DEDUCTION FROM ASSESSED VALUATION .?
State Form 03769(R11/6-09)
" Presanbed by Department of Local Government Finance .
File Mark I 2015
INSTRUCTIONS: .
Form i•• tltu
To be fled in person or by mail 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 • Coun t. •. I
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 C ' `l'•' - r.... .' IT 0R
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See reverse side for additional instructions and qualifications.
Applicant(owner or contract b&see numbest-- reverse side)r (� a� /7 ./y��}+
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wDD1 ><"\\v Key ��description 1M 1 .� F� u l Record number Page number
NUN District
so ac9- - a--0-1 Lk - off. `t -o,-15I a o 15 5 ( 8...
Assessed vale teal propay as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
March 1:current year March 1,event date of application legal or equitable owner?
b 5 jrn)a • [! s ❑ No
If no what is his r 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:
r!of mortgagee or contract seller '
Address of mortgagee or contra seller(number am
C._.J
Name of assignee or other owner or holder of mortg
oJ � QJ —
Address of assignee(number and street city,state,
Does applicant own property in any other
county in Indiana?
❑ Yes RP No
Deduction approved In the amount of: aQ,S - S 6
20 20 7 -),5 1 v o v
•
Signature of County Auditor _. _--. �...-•••r
i
. I 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 data application is filed. .
Signawner's na (month,me) Date(n ,day,year)
rl/Yl 3-3o-!S
Full dent address of applicant(number{�•rpN`annd sheet,ay,state,and ZIP code)
P son authorized by duly executed PoweFbf AvomeY or by IC Gtn� n IN �� �v Date(mooch,day,year)
Address of authorized person (number and street city,stale,and ZIP rode) .