HomeMy WebLinkAboutMortgage_Mabrey (2)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION oun Township Year
��'. «• �.� Siate Fwrt: 43709 (R5 / 4-03) �
PiexnEed Ey Department of Loral Govemmeni Finance
iNSrRUCnoNS: APR 2 � 20�� Ma,�
To be filed in person or by mail with the County Auditor of the county where the property is located�
Filing Dates: 1) Real Property: Ounng the 12 months before May 11 0/ the year the deduction is ro�6e eHeck6'e.!��
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March Ql��y�e��he dedi/ction is to 6e effective.
See reverse side for additional instructions and qualifications. �TY AUDITOR
Applicant (owneror tract uyer- see tn tions on rev rse side) � '�
- - - ^�- �. -06
Taxing Distrid Key number / leg scription Record number �
'" ' "' a _ '� • Page number �
U 8' �O
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, currenf year March 1, current year - owner? �'es ❑ No
0,.3.95� oo ,
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than lhat o� Is the property in question:
Drawer N0.4?. �-.."�'3C'd' t�i�a&+v ❑MobileHomepC61.1-�
�e of mo a ee or contreIX seller _,�
Card NO . .....................
Addres of mortgagee or contrad seller i
Name of assignee or other owner or holdc� u� mungage '
Address of assignee (num6er and sfinef, city, state, ZIP code) -
Dces applipnt own property in any other If yes, what county? What Taxing District? Has this deduction been requesfed on
counly in Indiana?
property for current year?� Yes❑ No
cp_r__�,� � ��� _ COUNTY AUDITOR 3 7
Deduction approved in the amount of:
20 v� 20 _�_g_ 20 _Q� 20 2D 20 20
� P 3
Signature Cou ty Auditor Date
We certiiy under the penalty of perjury ihat the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
ign re (owners�l na9�e) Person authorized by duly executed Power of Attorney
�■✓�.. �Y li I or by IC 6-1.1-12-.07
Futl resident address of applicant Address oT authorized person