HomeMy WebLinkAboutMortgage_Bryani�� 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i' � FOR DEDUCTION FROM ASSESSED VALUATION o �P Year
�e-, I State Form 437W (R6 / 5-06)
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� Presaibed by Department of Loral Govemment Finance FEB p Q 200�
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INSTRUCTIONS: v'`a�(/ �a�
To be /iled in person or by mail with the CountyAudifor ot the county where the property is /ocal�MBSON CO�NTY AUDITOR
Frling Dates: i) Real Property: Dunng lhe 12 months before ,lune I1 0/ the year the deduction is to be eBective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year fhe deduc6on is to be e(fective.
See reverse srde for additional instructions and qualifications.
Applicant er or cont�act buyer - ee restrict' s on reverse side)
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Taxing Distrid Key n mber / legal descriplion Record number � i1 i1 /_
C�� �n-�tJ o�b - i 3- a 8- 3 00 -eO�, �� ,�
Y _ Page number � � C �
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Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March�cunent year ownef? ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is lhe property in question:
❑ Real Property ❑ Mobile Home QC 6�1.1-�
e of moRgagee or contraQ seller " O��G�/
Address of mortgagee or conVact selier (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Addre; code)
Drawer NO.a��%C..-.� v� �
Does a ����' unty? What Taxing District? Has this dedudion been requested on
county property for current yeaR � Yes ❑ No
Card NO . .....................
� G U�:ltccti
`� �02 � � 00 • ° ° COUNTY AUDITOR
Deduq._.. _��.--- .
20�_ 20 � � 20 20 20 20 20
P �° ��i
Signalure County Auditor Date
We certify under the penalty of perjury that the above and foregoing information is We and corred and that the applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owne/s full name) Person authorized by duly executed Power of Attomey
��•, or by IC 6-1.1-12-.OT
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ull resi ent ad ress of applicant Address of authorized person
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