HomeMy WebLinkAboutMortgage_Davis� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION T i Year
++ J State Form a3�09 (R5l a-03)
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� PtesvibeA by Department of Local Gtivemment Finance
2 S 2005
INSTRUCTIONS: File Mark
To be filed in person or 6y mail with the County Auditor of the county whe2 the property is located. �-y„
Filing Dates: 1J Real Property: During the 12 months 6efore May 11 o/the year the deduction is to be eflech e.°�'a
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the ��TzW�I �l�Ip�� ��ffective.
See reverse side for additional instructions and qualifications.
Appticant (own%� rcontra/cft buy�er-j see r
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Taxing Dislrict
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Assessed value of real property as of
March 1, curcent year
no, what is his / her exact share of
tions o reverse s�de)
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Key number / legal description
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Mortgage / Contrad indebtedness un{
March 1, current year
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If name on record is different than that of applicanl, indicate be
mongagee or contraa sener��
Record number ��
Page number Q
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as of Is the applicant ihe sole legal or equitable
owner? �Yes ❑ No
If owned with someone other than spouse, indicate with whom.
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Address of mortgagee or contract seller (number and slreef, city, state
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Name of assignee or other owner or holder of mortgage
Address of assignee (numberand st2et, ciry, state, ZIP code)
Does applicant own property in any other If yes, what wunty?
countyinlndiana?
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Deduc iot n approved in fhe amount ot:
20 20 ��
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Signature �
c•�. ,:., o►, � - ag-o5
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couNTV a
20 � 20 ��
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County Auditor
Date
We certify under lhe penalty of perjury lhat the above and foregoing intormation is true and corred and thal ihe applicants was / were
esident of Indiana and owner of the aforementioned property on March t, 20
(owners full
Person authorized by duty executed Power of Attorney
or by IC 6-t.t-12-.07
��ident address of applicant Address of authorized person
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