HomeMy WebLinkAboutMortgage_Dillard STATEMENT OF MORTGAGE ORCONT- • e, rtgINA�S`i10Couttty Township Year
J FOR DEDUCTION FROM ASSESSED VAL slab[!
State Forth 43709(R13I 10.15) I" r
Prescribed by Department of Local Government Finance
INSTRUCTIONS: LIOZ 9g d3S File Mark
To be filed in person or by mail. Form filed with:
Filing Dates' 1) Real Property.Must be completed and dated in the calendar ye- ,. , , • ..,.,.
sought
Must be filed or postmarked with the County Auditor or County ;rt4, e •% . the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding % -+.. 1O1
2) Mobile I Manufactured Homes not assessed as Real Property: --. I; .. ) the �.u u of the county ❑ County Recorder
whew the property is located during the twelve(12)months before March 31 of each y<:- the deduction is sought
See reverse side for additional instructions and qualifications. ,�///J
Applz(a7nt(owner or contract{buyer-see restrictions on reverse side) Cl
G f)r3-r' le Q- O n err l/; /_-`.
WO! Key number Legal description Record number Page number
M? Ca-Inc 26- /-i. -3o /co3. O856027 Q0/ 7 3//60
Assessed vakre of real property as of Mortgage I Contact indebtedness unpaid as of Mortgage 1 Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
FR / cord ,.:.. _ _ ❑ Yes ❑ No
If no,what is his/her exact share of interest? If Mat nf with someone other than spouse,indicate with whom— —
If name on record,s defererd than that of applicant,indicate below- assessed
ssessed
• rte(IC 6-1.1-7)
Name of mortgagee 0Mtr rr saner 0
Address of mortgagee or=tract seller(numbeyand sheet city,state,and ZIP code) ///�VV/111 (� /1�,1,,{ rte-•
Name of assignee or other owner or holder of mortgage {D/ 1 1 'C)y 1 ,�" 1
Address of assignee(number and street city,state,and ZIP code) �r I -"I-
Does applicant own property in any If yes,what county? What Taxing District% tdedWion
other county
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the in the county
recorder's office(including any home equity fine of credit that is recorded in the 1
COUNTY
Deduction approved in the amount of /J /`
20 20 20 20 I ' 1. 000 20
Signature of County Auditor
I/We certify under the penalty of perjury that the above and foregoing infon 4 Indiana and
owner I contract buyer of the aforementioned property on date application is
Signature(. = ful name)et
/L tr_"—i c r')
Full resident address of applicant(ember and street,city,state,
�and ZIP`coode) t
7�- i v `/ 3 IS,--0 i ,f V,c✓ 1. I t c 4 L/i i i i,.-, ✓�
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 )
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.