HomeMy WebLinkAboutMortgage_Grubb (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
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FOR DEDUCTION FROM ASSESSED VALUATIONCoun Township Year
StateForm43769 parR13/ ent oPrescribed by Department of Local Government Finance �`
INSTRUCTIONS: ;"-
To be filed in person or by mail. filed with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is t
Must be filed or postmarked with the County Auditor or County Recorder of the county where the propertNk 21 County Auditor
located on or before January 5 of the immediately succeeding calendar year ``VVvv,, unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
See reverse side for where eadditionaproperly
l slio located
s and qualifications.during the (12)months before March 31 of each year the deduction is spur,�rt, u,, PU�t‘C"
Appliant erorcontactbuyer-seere on verse side) 1 1 Gtgs0N Ct
Al
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Taxing District Key.rrymber1 legal description Record numg� Page number
rra,k o me Dco ,- toy - - ct3. 93(Q - 0a,1 / er 3)03
Assessed real p of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
-me*ssment date,current year assessment date,anent year date of applicably - w legal or equitable owner?
1 2 i Sc — es ❑ No
If no,what is his I 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 py in question:Annually Acwcctd
[dal Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
SA aveN..S.od tic_ 1 cO-C 9- n 7.,, —e-.CA . _, . Wv..A—a—.
Address of mortgagee or contract seller(number and sheet city state,and ZIP code)
Name of assignee or other owner or holder of mortgage __-1 - - __
Address of assignee(number and slfbet city,state,and ZIP code) r /Q r-1
Drawer NO G`/ ?V�
ones applicant own property in any If yes,what county? What Taxing District? H - n m
in Indiana? ❑Yes ❑No a 1 0
A person is not°MifMl to this deduction unless the person has a balance on the person's I Card NO. ccc// 3 natty
recorder's office(including any home equity line of credit that is recorded in the county rec
COUNTY AUDITOR
Deduction approved in the amount ob
20 20 20 _ 20 20 20 20
Signature of County Auditor County • Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
\S�" �)ure(ovmer s full name) Dale(month,1 �1 yet
1 e ident address
ft t( Il
W resident address of appfiant(number and street,city,state,and ZIP code) f
ELLS Lve,41 nk Sony �tt"e Qo )e no h Ile eSt\1 9'7 L1o1
P on authorized by duly executed Power of Attorney or by IC 61.1-t 2.0.7 Date(month,day,year)
Address of authorized person (number and skeet 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.