HomeMy WebLinkAboutMortgage_BengeSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
I State Potm 63709 (R5/4-03) ' .� . .. . ' . ' . . .. , ' . : + " .
Prescribed Oy Depertment ot Loral Gtiremment Financa
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INSTRUCTIONS:
To be filed in person or by mail with the Counry Auditor of the
Filing Dates: 1) Real PropeRy: Dunng the 12 months be(ore ,
2) Mobile Homes assessed under IC 6-1.1-7: Bf
See reverse side for additional instructions and qualifications.
Appliwnt (owner or ontl�ac b ryer - ree
Tauin istrid
.
sessed value of real property as of
March 1, curtent year
If no, what is his / her exact share of interest?
reverse
File Mark
y where the property is located. .—� �, _., t
ol the year the deduction is to 6e eflect� .� r� ��
January 15 and Marcb 2 0/ the year tlie deducBon is to be effective.
JUL 14 2004
/` . // n i:
Key number / legal description
��rGl9SONC0U�ITY r+'.tr,��"
Record number 6 2
Q� O � /�Q ��0� �� Page number
MoAgage / Contrad'��n�debtedness unpaid as of Is the applicant the sale legal or equitable
March 1, cunent year (P 6 � q3O � owne(? � Yes ❑ No
If name on record is difterent than that of applicanf, indicate below:
moAgagee or wntract seller
of mortgagee or contrad seller (number and sireet, city,
Name of assignee or other owner or holder of mortgage
with someone other than spouse, indicate with whom.
� � ��1, ���
Atltlress�of assignee (num6erand street, city, state, ZIF code) ,, ,, . _,
Dces applicant own property in any other If yes, what county? What Taxing Distrid?
county in Indiana?
Dedudion approved in ihe amount of:
2�
Signature
COUNTY AUDITOR
zo ���i� zo Q I zo P 20
�-o
County Auditor
❑ Real Property � Moble Hane QC &1.1-�
. � .. . . . . . ;'i', . .
Has this dedudion been requested on
property for current yeaRQ Yes❑ No
20
20
/ We certify under the penalty of perjury that the above and foregoing informalion is true and corred and that the applipnts was / were
resident of Indiana and owner of the aforementioned property on March t, 20
gna ( e/s� � Person authorized by duiy execuled Power of Attomey
or by IC 6-1.1-12-.07
L
�II resi ent address of applicant Address of authorized person