HomeMy WebLinkAboutMortgage_Ferry .rx ., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
#' ; FOR DEDUCTION FROM ASSESSED VALUATION
'7 ! . -
if;,I-'. State Form 437g9(R731 10-15)
S ===-1 Prescribed by Department of Local Government Finance
•
INSTRUCTIONS: I
• 9:•� ', icfirk/
To be filed in person or by mail. • , Form fi
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the ded .. 4.: / A01
Must be filed orposbnarked with the County Auditor or County Recorder of the co a property i o pt udito
located on or before January 5 of the immediately succeeding calendar year. Co rder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County A ' of t
where the property is located during the twelve(12)months before March 31 of each year the sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contact buyer-see restrictions on reverse \J\side), � ?atOQ\fi
VAX Y� 1 `�'1-tr\
Taxing District nu l legal description Record number Page number
CAIkart$.1& TL)rft -I\-1 -01D - ACID-000 . a to.- obQ 2 _( 01 S--
A•mssed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,aurem year date application ^-pp�� legal or equdable owner?
R M0 0 Yes 0 No
If no,what is his I her exact sham of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of appliant,indicate below. Fe
operty m questiiLton:Annually Assessed
HOrrM(IC d67.1-7)
Name of mortgagLIP'eeorn 4 O contract� se
Address of mortg or q o ZO�JageA contract seller dstreet city,state,and ZIP code) JAN n
Name of assignee or other owner or holder of mortgagey/-�p _
•
Address of assignee(number and street,city
02-O / s
Drawer NO - GIBSO�UNTOR
�applicant own property in any If yes, ton been requested If yes,state amount of deduction
in Indiana?couy ❑Yes ❑No Card NO. ' ❑Yes ❑No
A person is not entitled to this deduction r contract indebtedness that is recorded in the county
recorder's office(including any home eq e)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
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 correct and that the applicant is a resident of Indiana and
owner/contract buyer ofi thep/ aforementione
d property on date application is filetm�+�,)�)JJ(.' aI0
4 Dar
•
)(1ufl resident addressof applicantin�u'mbber ar7��1')m�jee.L. state and ZIP /� ��` \� —7
Person\ `authorized by exeatetl-k-- AttorneyA: ICt.ttt2L n c 0Li 1 D. 4r 1d Lo o O .
Address of authorized person (number and athet city,state,and ZIP code) U
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. � -