HomeMy WebLinkAboutMortgage_Williams (13)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�'. / State Fwrr. a3709 (R5 / 4-03)
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� Presrnbed by Departmem ol Laal Govemment Finance
INSTRUCTIONS: � � � �jFil Ma
To be �led in person or by mail with the County Auditor of the county where the property is lo t d. �/
Filing Dates: 1) Real Property: During the 12 months be%2 May 11 0! the year the deductio to e e ect�ve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 0/ the y�7c thZdid� is to be e/fective.
See reverse side /or additional instn�ctions and qualifications.
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Applicant (owner or qpntract 6uyer - see restrict' n n e side)
1 �,,�,,,� OIBSON COUNTY AU0�70R
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Taxing Disirid Key number / legal description Record number D
1��•� ���—�.J� J oio�� C� Page number �7��0
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Assessed value of real property as of MoRgage / ContraU indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curcent year ' March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? Ii owned with someone other than spouse, indicate with whom.
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If name on record is different than that of applicanf, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Hane (IC Cr1.1-�
�me of mortgagee or contrad seller
Address ot mortgagee or contracl seller (number and street, ci , tate, ZIP
Name of assignee or other 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 Distrid? Has this deduction been requested on
county in Indiana? propeAy for current year? � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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20 2a ` 2L�Q g 2�� 2� 20 2�
1 �� �
Signature County Auditor •= . Date
We certify under the penalty of perjury that the above and foregoing information is true and correcf and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) _ Person authorized by duly executed Power of Attomey
� � or by IC 6-1 J-12-.07 � _
F I ident address of a icant Address of authorized person
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