HomeMy WebLinkAboutMortgage_Williams (5)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�+ / State Fwm a3709 (R5l a-03) '
,«.
� PmscnEetl �y Depanmeni of Loral Govemmem Finance
INSTRUCTIONS: � � � � �
To be filed in person or by mail with the County Auditor o/ the county where the propeRy is located.
Filing Oates: 1J Real PropeRy: Dunng the 12 months be%re May 11 0/ the year the deduction is to 6e effec
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0! the year the dedu is to,be ective.
See reverse side for additional instructions and quali�cations. ��� V 0 2�4
- see
side)
:ey number / legal description � Record number A
Q � � �� V ��� Page number /"
l� � /
TtsseSs�d value of real property as of MoRgage / ContreU indebtedness unpaid as of Is the applicant the sole legal or equitable
March i, curtent year March 1, current year O owner? ❑ Yes ❑ No
/ / O
cs� cii
If no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate wilh whom.
-�6 �/- �oa - aa'd. 9� s� C� /
If name on record is different Ihan lhat of applicant, indicate below: Is the property in question:
of mortgagee or contrad seller
of mortgagee or contract seller (number and sf2et, city, state,
Name of assignee or olher owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District?
county in Indiana?
Dedudion approved in the amounf of:
20 20 �
P�
Signature
COUNTY AUDITOR
20 0 20
P
County Auditor
al Property ❑ Mobile Hane (IC 67.
Has this dedudion been requested on
propeAy for current year? � Yes � No
20
Date
20
certify under the penalty of perjury lhat the above and foregoing information is irue and correc[ and thal lhe applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
(owners
Person authorized by duly executed Power of Attorney
or by IC 6-1 J-12-.07
of applicant IAddress of authorized person