HomeMy WebLinkAboutMortgage_Hill1� �(� � =- � � � c�
!CI � STA�EMENT OF MORTG E OR CONTRACT INDEBTEDNESS � �
.
� FOR DEDUCTION FROM A SSED VALUATION Counry" il T3w'sh Year
V's w. / s�are Form a3�os (R5 i a-03) /,///�.�� �' �l �
�!/� PresaiDed Dy Depanmeni of Lorai Govemment Fin nce :-� i// //Jl � 1
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INSTRUCTIONS: �-y� Fi�Marlc ��
To be (!ed in person or 6y mail with the County Auditor of the county whe�e [he property is located. �/'��j
Fi ling Dates: 1) Real Property: During the 12 months before May 11 0/ the year fhe deduction is to 6�e�e�gerlive� � NTY� ITOR
2J Mobile Homes assessed under IC 6-1.7-7: Between January 15 and Maich 2 0) the year t�ie �eduction is to be eNective.
See reverse side for additional instructions and qualifications.
Applicant (owner or contracf buyer- see restrictions on reverse side)
Taxing Dislrict Key number / legal description
��-�a-i3-3oo-000. cvs�-oo�
ilprr vo � -oo �-Y�/- cr�
Assessed vatue of real property as of Mortgage / Contract indebtedness unpaid as
March 1, current year March 1, current year
If no, what is his / her exact share of interesl?
If name on record is different lhan ihat of
moRgagee or contract seller
Address of moRgagee or contrad seller
Record number
�
Page number
Is the applicant the sole legal or
ownef? �es ❑ No
5cac� �
If owned with someone other than spouse, indicate with whom.
indicate below:
Name of assignee or other owner or holder of mortgage
city, state, ZIP
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant ovin properfy in any olher If yes, what county?
county in Indiana?
What Taxing District?
I�JL £ �� ��_ a_�� / y�� COUNTY AUDITOR
7
Deduction approved in the amount of:
20 Q� 20 � 20 �_ 2 20
� P � 13
Signature County Auditor
property in question:
❑ Mobile Home QC Crt.
Has this deduction been requested on
property for current year? C] Yes ❑ No
20
Date
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and lhal the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
(owners full
address
3
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Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person