HomeMy WebLinkAboutMortgage_Messersmith�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- ' FOR DEDUCTION FROM ASSESSED VALUATION Co Township Year
, d � St3te Fortn 43709 (R4 / 10-01) ��
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� Presaibed by DeDartment of Local Govemmeni Finance
MAY 0 7 �003
INSTRUCTIONS: File Ma
To be filed in person or by mail with the County Auditor of the county whe�e the property is located. � �
Filing Dates: 1) Real Property: Dunng the 12 months befo2 May 11 of the year the deduction is to b 've.�l-� �� �
2) Mobile Homes assessed underlC 6-1J-7: Between January 15 and Ma�ch 31 o/the yesti4�a%�'d�jo5�ys�(q�6e'�ctive.
See reverse side for additional inst�uctions and quali(ca6ons.
buye�-
Taxing
�L.7/�Cli� C'� lLJ
Assessed value of real property as of
March 1, current year
no, what is his / her exad share of interest?
on
Key number9legal
Record number ���a
�/� : �/�� �� Page number �� ��
�AoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
�Aarch 1, curtent year owneR ❑ Yes ❑ No
c.���c�
If owned with someone other than spouse, indicate with whom.
If name on record is difierent than that of appliwnt, indicate below:
�ame of moRgagee or contrad seller n. i .
/ �/ 0.�60
- 13'� y- O^I'-ES�, �-IO -0�5
Is the property in question:
❑ Real Property ❑ Mobile Home pC G1.1
Address of mortgagee or contract seller (number and,Sir�et, city, sfate, ZIP -- --
lJ �
Name of assignee or other owner or holder of mortgage Drawer N�..:�.`^:.�.....
Address of assignee (number and street, city, state, ZIP code) Card NO. .... �� J
..............
Dces appliqnt own property in any other If yes, what county? What Taxing ��� cm � on
county in Indiana? property for curtent yeaR � Yes ❑ No
20
Signature
approved in the amount
20
COUNTY AUDITOR
20 Q,Z 20 20
�
County Auditor
20 ��
�
Date
�
�
/ We certify under the penalty of perjury that the above and foregoing infortnation is lrue and correct and that the applicants was / were
resident of Indiana and owner of the aforemenlioned property on Marcn 1, 20 .
(owners (ull name)
_� �� �
Person authorized by duly executed Power of
or by IC 6-1.1-12-.07
resident address of applipnt � �Address of authorized person