HomeMy WebLinkAboutMortgage_Godleye°' ��n° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
ir -` �: FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
; y SUIe Porm 43709 (R4 / 70.01)
�� Prescribed by DepaMent of Loral Govemment Fnance
SEP � 0 2002
INSTRUCTIONS: File Mark
To 6e �led in person or by mail with the County Auditor o/ the county where the propeity is located������ ����
Filing Dates: 1) Real PropeRy: Dunng the 12 months belore May 11 o)the year the deduction is to J�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0/ t y@�36Y4�6U�tioh f�.YDib�F� ctive.
See reverse side lor additional instructions and quali�cations.
ons on rever id
e number legal description
na � -�o�� �/-�
Assessed value oi real property as of Mortgage / Contrect ii
March 1, current year March 1, current year
�
If no, what is his / her exact share of interesl?
If name on record is difterent than that of applicant, indicate below:
of mortgagee or coniract seller
Address of mortgagee or contrad seller (number and
Name of assignee or other owner or holder of mortgage
as
Record number
Page number � / O
Is the applicant the sole legal or equitable
owne(? ❑ Yes ❑ No
��
If owned with someone other than spouse, indicate with vrhom.
.i�� . „7/� _ /�.� _.�n C� /YYl /��JJO 3
city, state, ZIP
Address of assignee (numberand st2et, city, sfate, ZIP code)
Does appliwnt own property in any other If yes, what county? What Taxing Distrid?
county in Indiana?
Deduction approved in lhe amount oi:
20
Signature
20
COUNTY AUDITOR
220 20 20
:1
County Auditor
❑ Real
O Mobile Home (IC &1.1
Has this dedudion been requested on
property for current year? �] Yes ❑ No
20
�
20
�
We certify under the penalty of perjury that the above and foregoing information is true and correct and thal ihe applicants was / were
resident of Indiana and owner of the afo�,gmentioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
�r�-aoo�ss���Q/ ��Qi, n�'�_ �Nw�;"�tnonzeaperson