HomeMy WebLinkAboutMortgage_Seib (5) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN P
Fes;. T t'Cp j,ft ownship Year
: u
; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709cRmento A )2 q.g 20151
Prescribed by Department of!oral Government Finance
File Mark
INSTRUCTIONS: IIf
am coed with:
To be filed in person or by mail with the CountyAuditor or County Recorder of the county where the pmpedyis-, ca-Ced.• �7�
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. TY AU DI�R County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Re during F251��12J am
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for additional instructions and qualifications.
AppGertiownor orcontradb see on sale)
rUa Ccr �S�G-
Tatirg D' Key number/legal description Record number Page number
1 I�/I Pn 6—i at—/ 9- ivo or) iai eo era ,", la. g
March 1:aatie year property as of Mortgage a�aindetted unpaid as of Mortgage P�indebtedness unpaid as of Is t Hm or equitable owner?
X05/a 6 ❑ Yes ❑ No
If no,what is his/her exact share of interest? I 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
ISa2eal Property ❑Annually Assessed
• `/ Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street ciry,state.and ZIP code)
Name of assignee or other owner or harder of mortgage
rX 0\-3—
Address of assignee and sheet,city state,and ZIP code) V
s C. SQOv d •
hiy: es-v1 Sego
Does appll ant own property in any other If yes,what county? • Y��t ....•\ ��!uested of Property
coo m Indiana?
❑ Yes ❑ No _ Dral\Cl- OA \Av ,,,,-- - ] Yes ❑ No
Deduction approved in the annum oh • Card NO' ...;-t-'.` -a \2-
20 20 20 20 1 20 20 20
Signature of County Auditor • County Date(month,day,year)
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 date application is filed.
Slg owne/s Mt name) c' Date(month,day,year)
Full a5 01 1 t s>r00 state,aeduPFet c�
pan c h be
Person authorized by duty executed Power of Attorney or by IC 6-1.1-1 2-0.7 Date(month,day,year)
Address of authorized person (number and street,city:slate,end ZIP code)