HomeMy WebLinkAboutMortgage_Strickland (2)STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun r�,y FtToNNNwnship„ Year
�a ,«. / State Fwm 437W (R5/4-03) ' . '.. � " . . . • F7 ' �� � ��—� !
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� P2saiCetl Ey Department of Loral Govemment Finance �J
' 3 ' 004
INSTRUCTIONS: File Mar�k%-
To be filed in person or by mai! with the County Auditor ot the county where the property is located. . � ��, `�/
Filing Dates: 1 J Real Property: Dunng the 1 months be%re May 11 0) the year the deduction is to 6e�effectiv� e !�^J;<�,c�,.�
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2) Mobile Homes assessed un�er IC 6-1.1-7: Between January 15 arid March 2 0/ the year !he deduction'is` to be effective.
See reverse side for additional instructions and qualifications.
(owner
District
Assessed�alue of real
March t, current year
�- see restrictions on reverse side)
�
� Key number / leg I e
O J (
as of MoAgage / ContraU ii
March 1, wrrent yezr
If no, what is his / her exact share of interest?
If owned
If name on record is different than that of applicant, indicate below:
'ame of mortgagee o contract seller (� (�
a eao p1�' P alC X 6�. �
Address of mortgagee or contrad seller (number.andstreet, city, state. ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street,
Does applicant own property in any
county in indiana?
Deduction approved in the amount of:
zo
Signature
�tate, ZIP code)
Record numbe�
Page number
unpaid as of Is the a�plipnt the sole legal or
owne(? ❑ Yes ❑ No
someone other than spouse, indicate with whom.
�a�e
If yes, what county? �\Nhat Taxing Distnct?
�r��m
COUNTY AUDITOR
/ zo c�s
I �
_ County Auditor
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r�
Is the
•� �
❑ Mobile Home (IC 61.1-�
Has ihis deduction been requested on
property for current year?� Yes� No
�
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/ We certify under the penalty of perjury that the above and (oregoiny information is true and correct and thal lhe applicants was / were
� resident of Indiana and owner of the aforemen;ioned property on March 1, 20
gna/ty��e�(owners full lnname) � Person auihorized by duly executed Power of Attorney
Pi\ YMmn (�/i� � n/n � n or by IC 6-1.1-12-.07
�t adcdre�s,s� of/a,p�plica%� Address of authorized person
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