HomeMy WebLinkAboutMortgage_Houchins (4)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
°- M� / Stata Fwm 43709 (RS / 4-03) T
� Prescribed by Department of Loral Govemment Finance u�
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�NSrRUCnorvs .1AN � ��@05
To be filed in person or 6y mail with the County Auditor o/ the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months 6elore May 11 0l the year the deduction is to be elfec ' �!'
2J Mobile Homes assessed under IC 6-1.1-7: 8etween January 15 and March 2 0/ the year theki�o}�a+�gpe elfective.
See reverse side for additional instructions and qualifications. D��N COUNTY UDlTOR
orr,pntractbuyer.
reverse
Key number / legal description I Record number Q
/� L� � /}�-� .� _ ��/ _ / �l Page number �
l,f.LC,�� �t.os 'j" UCJ
Assessed value of real property as of Mortgage / ContraU indebtedness unpaid as of Is the applicant the sole legal or equitable
March 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.
�/ - /�? -�//jJ- 000. .3/5L (JC�"
If name on record is different than that of applicant, indicate below:
�e of mortgagee or contrad seller ��
Address of mortgagee or contract seller umber and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
❑ Real Property � Mo6ile Hm�e (IC 6-1.1-�
_ a�-8g��7
Drawer N�.... •
Address of assignee (num6er and streef, city, state, ZIP code)
Card ��• "
Does applicant own property in any other If yes, what county? What quested on
county in Indiana? ._. ,,,,�rent yeaR� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 20 20 �
� �
Signature
20
P I �/i3
County Auditor
20
20
We certify under the penalty of perjury lhal the above and foregoing information is true and correct and that the applicants was / were
;esident of Indiana and owner of the aforementioned property on March 1, 20
full
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
oi applicant J �Address of authorized person