HomeMy WebLinkAboutMortgage_Heldt (6)^•n
STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION� g g
�• ! Sute Form a37�9 �R51 a-03) 1
�� PrescnDed by Department of Loral Gdvemment Finance J�J
MAY
%
n Township Year
INSTRUCTIONS: File Mark
To be filed in person or by mail with the CountyAuditor of the county where the prope��ylgCat��
Filing Dates: 1) Real Property: During the 12 months belore May 77 of the year the de cfi�s to b efI�{�e. ,
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 �n��f�t�MTii� }�9�he deduction is to be effective.
See reverse side !or additional instnictions and qualifications.
�
Applicant ( restnctions o_ n reverse
� �� . . _
�,3[,Q�rT�{�.
Taxing District Key number / legal description Record number O�
` r}.. � � _ / � _ ^ „ Page number
� b W
Assessed value o( real property as of MoAgage / Contracl indebtedness unpaid �f Is the applicant the sole legal or equitable
March 1, wrrent year March 1, current year I-����p, owner? ❑ Yes ❑ No
g
If no, what is his ! her exact share of interesl? If owned with someone other than spouse, indicate with whom.
-13- - o. � l - b5
I( name on record is different than that of applicani, indicate below: ' Is the property in question:
❑ Real Property ❑ Mobile Hwne pC 61.1-�
�me of mortgagee or contract selier
Address of mortgagee or contred seller (number and street, city, te, ZI �
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 I( yes, what county? What Taxing District? Has ihis deduciion been requested on
county in Indiana? property for current year?LJ Yes� No
COUNTY AUDITOR
Deduction approved in ihe amount of:
20 20 � 20 �� 20 �� 20 20 20
r� p �a� P �
Signature County Auditor Date
' We certify under the � enalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
resident iana a owner of ihe aforementioned property on March t, 20
Si ner (u na person authorized by duly executed Power of Attomey
or by IC 6-7.1-12-.07
u re t address of applicant Address of authorized person
P. � al� �'��sQ�-L