HomeMy WebLinkAboutMortgage_Jones (20)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
= �! SH;aForrt:43709�(RS/4-03)
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Presvibed by Department of Local Govemment Finance
INSTRUCTIONS: � � - � � � File.Marli
To be /iled in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months be(ore May 11 of the year the deduction is to b�,effie�v�
2J Mo6ile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 oI the year th d d�� is to be effective.
See reverse srde for additional instructions and quali(cations.
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Applicant
Tauing
Assessed value of real property as of
March 1, current year
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Key number / legal description
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Mortgage / ContraG indebtedness unpaid as
March 1, �year
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if no, what is his ! her exact sbare of inierest? �
If name on record is different than that of applicant, indicate below:
of mortgagee or contract seller
Address of mortgagee or wntrad seller (number and street, c�
Name of assignee or otherowner or holder of mortgage
Address of assignee (numbe�and street, city, sfate, ZIP code)
Ooes applicant own property in any otl
wunty in Indiana? �
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Deduction approved in the amount of:
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Signature
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If yes, what counry?
Record number
Page number
Is the applicant ihe sole legal or equitable
owner7 ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
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Is the property in questian:
❑ Real Property ❑ Mobile Home pC Crt_
What Taxing District?
�_ Drawer 1�'0..�.�.i(b �
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Card NO. ..,,`��,YO��
'�'�'��dCO�`n ....
20,�_ �„ _
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County Auditor
Has this deduqion been requested on
propeAy for current year? � Yes � No
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Date
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We certify under the penalty of perjury thal the above and toregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
3nature (owners (ull name) Person authorized by duly executed Power of Attorney
n�,,,, �,, Q/ �, �� J or by IC 6-7.1-12-.07
aivcu� auvica�v� ayyuwni � Haaress or auinonzea person
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