HomeMy WebLinkAboutMortgage_Stone (2) € STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. ; ta FOR DEDUCTION FROM ASSESSED VALUATION
Puts Prescribed 43769(part 10-15)
nt o T
- " Prescnbed by Department of Local Government Finance 1
INSTRUCTIONS: File Mark
To be filed in person or by mail. CC Form filed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for whit hi6 atclacidh1ih sought r—�,co�
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is is unty Auditor
located on or before January 5 of the immediately succeeding calendar
2) Mobile/Manufactured Homes not assessed as Real Property:Must file R r : •� -,'r• •r of the county County Recorder
where the , fir' r:�:we-.7!
properly during tcaions. (12) before :- •*N COON Y AUDITOR
deduction is sought
See reverse side for itionel instruction and qualifications. G
Appbtant(own a rer rtcriotreverse side)
T Key number/legal Record a number
trio �c II - you-an/ 7�/oa! � a/ 1
Assessed value property at M• •e/Contact indebtedness unpaid as of Mortgage l Contract indebtedness unpaid as of Is the applicant the sole
assessment date, year "---_r d(��eq/urr�e"ra�yg��/�� date of apt/cation legal or equitable owner?
�.�W t, )1951 JC) ❑ 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 Is the property in question:Annually Assessed
❑Real Property ❑ AnnuauyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ti-etaQ Q3 -u. k_
Address of mortgagee or contact seller(number and " ,state,and Z/ code) r
Vl
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does (� axing District? Has this deduction been requested If yes,state amount of deduction
m
other Ind S1�N(i Irw4(2"� aaiirrenrnt property ❑Yes 0 No
A pen (Z e p( G ante on the person's mortgage or contract indebtedness that is recorded in the county
reewo U 1'� tiled in the county recorder's office)that is the basis for the deduction.
Deduce
-1—. (a60 COUNTY AUDITOR
2( I I __ l 20 20 20 20 20 •
Signs -of.• j Ate w ,p County l Date(month,day,year)
�� l -L .l'L , . tI _
I/ .e •-miry under the penalty of perjury that the a�oing 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.
Sig ( full nam j Date(month,day,year)
Ir 7/1/ . �- -
u6 resident address of applicant(number and street city,state,and ZIP code)
i 5-771/ VI/ S/ /6 (f /) ./1Q,r,-t. 5�7z G S
(Person
outhunted by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.