HomeMy WebLinkAboutMortgage_Harris (2)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Yea
S w� J State Fam 43709 (RS / 4-03)
� PrescnD�d by Department of Loral Govemment Finance
INSTRUCTIONS: � � � ile
To be filed in person or 6y mail with the County Auditor of the counry whe�e the property is locat
Filing Dates: 1J Real Property: During the 12 months belore May i 1 0/ the year the deduction is to be ��ive� ��nQ3
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the ye Fh� d4d ct 11 �s to 6e eflective.
See reverse side for additional instiuctions and qualifications. � ��� /� �]
or contract 6uyer - see s nction�j on reverse
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Taxing
Asses�ed value of
March t, current yi
Key number / legal description
� �/�-�%G-�
property as of MoAgage / Contrad indebtedness unpaid as
March 1, currenl veav'
If no, what is his / her exact share of interest?
If name on record is
of applicant, indicate below:
�3me of mortgagee or wnlred seller n Q�
C�yX.
Address of mortgagee or contract seller (number and street,
Name of assignee or other owner or holder of mortgage
(number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
2�
.-.�,�
Signature
the amount of:
�
Rewrd number � �
Page number / �
Is the applicant the sole legal or
owneR ❑ Yes ❑ No
owned with someone other than spouse, indicale with whom.
- - IS -c�.o'-� - - �� O 3.
Is the property in question:
❑ Real Property ❑ Mobile Home QC Fr1.
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What Taxing Dislrid?
COUNTY AUDITOR
20
County Auditor
a_� AFpn
t
Has this dedudion been requested on
property for current year? � Yes � No
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03 � l� _
, �ate
,
We certify under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
��ture (owners (ull name) Person authorized by duly executed Power of Attomey
n_ Q. . /,j __ or by IC 6-1.1-12-.07
Full resident address of applicanl M� ��cs� � vJ Address of authorized person
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