HomeMy WebLinkAboutMortgage_Cullen; ��� �
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
•�j, Stale Fwm 43709 (R6 / 5-06) � �
�� Presvibed by Department of Loral Govemment Finance
INSTRUCTIONS:
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To be (led in person or by mail with the County Auditor of the county where the property is located. � '
Filing Dates: 1) Real Property: Dunng the 12 months before June 71 0( the year the deducUon is to be efi l� �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 o/th@I�2!tbEde,GfUCf(opU9fodr8 eBective.
See reverse side lor additional instructions and qualifrcations.
Applicant ( wnerorconfract buyer- sGe restnctions on�
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Taxing Distrid Key number / legal description Record number � o o � _
�^a'-/v1�-�'`-�C./ (C - 20 - � o� " OZ �� -O D 0, Z�� 3 Page number �G' l�
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Assessed value af real property as of Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
Marcli 1, current year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If nam n record is differ than that of applicant, indicate below: Is the property in question:
°f' O� j��. ❑ Real Property ❑ Mobile Home (IC &1.1-�
�me of mortgagee or contrad r -
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Address ot mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage j� �':1��'��� ��"
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Address of assignee (number and st�eet, city, state, ZIP code) C;� �-�� \ �•••••"
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Dces applicant own property in any other If yes, what couniy? What Taxing Disti nas this dedudion been requested on
county in Indiana? property for current yeaR 0 Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amouni of:
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20 20 �_ 20 �9 20 20 ZO 20
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Signature County Auditor Date
I We certify under the penalty of perjury lhat the above and foregoing information is true and correct and that the applicants was / were
reside of Indiana and ow r of lhe aforementioned property on March 1, 20
Sipnatur owners full n m - Person authorized by duly executed Power of Attomey
-� or by IC 6-7.1-12-.07
Full esident addr s of appliwnt Address of authorized person
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