HomeMy WebLinkAboutMortgage_Mutchman�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Yea
: -�� �I State Fwrt; 63709 (RS / 4-03)
- PrescnoeE by Depanment of Local Cwvemment Finance
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INSTRUCTlONS �� � � �File Mark/
To be fled in person or by mail with the County Auditor of the county where fhe property is located.
Filing Dates: 1) Real Property: During fhe 12 months before May 11 of the year the deduction is to be:effective. LUU3
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0/ the yea� �he deduction is to 6e effective.
See reverse side !or additional instructions and qualifications.
Appliwnt
Taxing
orFontract, buyer - see restnctions on reverse side)
Key number / legal description
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Rewrd number � �
Page number ��� �
Assessed value of real property as of � Mortgage / ContreG indebtedness unpaid as of Is the applicant the sole legat or equitable
March 1, current year March 1, curren�ear owner? ❑ Yes ❑ No
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If no, what is his I her exacl share of interest? If owned with someone other than spouse, indicate with whom.
�G o?o �P-�QO _�,�/. 7�s =doi
If name on record is different than that of applicanf, indicate below: Is the property in question:
of mortgagee or contraU seller
Address of mortgagee or contract seller (numbes/�nd street, city, state. ZIP
Name of assignee or other owner or holder of mortgage
.\ddress of assignee (number and streef, cily, state, ZIP code)
Does applicant own propeAy in any other If yes, what county?
wunty in Indiana?
Deduction approved in the amount of:
Zo cY 20
SignaWre n� n
couNTr a�
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County Auditor
� Rea� Property ❑ Mobile Home (IC 67.1-�
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is dedudion been requested on
y for wrrent yeaf? CJ Yes ❑ No
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Date
I/ We certify under the penalry of perjury that the above and foregoing information is true and corred and that the applicants was / were
�esident of Indiana and owner of the aforementioned properly on March 1, 20
(owners full name)
Person authorized by duly exewled Power of Atlorney
or by IC 6-1.1-12-.07
address of applicant �Address of authorized person
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