HomeMy WebLinkAboutMortgage_Ellis (5) , . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Township Year
„: FOR DEDUCTION FROM ASSESSED VALUATION
' State Formrl37tH MU/6-09) I .
Presmbed by Departmerd d Lopl Gavanmend Fnaroe
p C File Mark
INSTRUCTIONS: 11((���� 2 O 2015
To be filed in person or by mad with the County Auditor or County Recorder of the county where the pa is orated. F filed
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. 0 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Re during the twelve 12}m 1-D
before March 31 of each year the deduction is sought. UNTY pUDITO County Recorder
See reverse
d—.'.'.f ni Record number Page number/its _/n 6 -002 COQ_ cub /rO/aaC acv lo 5 7
- vatue of real property as of Mortgage/Contract indebtedness unpaid as at Mortgage I Con i debtedness unpaid as of Is the applicant the sole
March r;orrva year Marrdt 7�a ti �garac date of apprxanon legal oO equitable O
`•'•1/1.x/1 C//1 Yes No
If no,what is his/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. do properly in question:Annually Assessed
I Properly ❑Annually ryy Assessed .1-7)
Name pFawrtgagee or tract Seller TTTTT
Address�of mortgagee or contract seer and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,rip:state,and ZIP code)
Does applicant own property in any other If yes,what county? • What Taxing Di stria? Has this deduction been requested on property
❑ Yes ❑ No for current Yin ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 21) 20 20 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
-r contract buyer of the aforementioned property on date application is filed.
Si. .,re(o A • fu9 name) • Date(month,day,year)
1
Full is." -;,,:sw1.of a (num and sbee oily,state,and ZIP code)
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,dry state,and ZIP code) .