HomeMy WebLinkAboutMortgage_Old National��� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION Cou own " ear
ti. ! SWteFOrma37091R51a-03) I
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PrescnOed by Depertmeni ol Local Guvemment Finance A R 2 9 200
INSTRUCTIONS:
To be )iled in person or by mail with the CountyAUditor o! the county where the property is located. �
Filing Dates: 7) Real Property: During the 72 months belore May 77 o/the year the deduction is to be ��� C� TY AUDITOR
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to 6e ef(ective.
See reverse side !or additional instnfctions and qualifications.
Taxing Distrid
Q1�2xQ�
Assessed value of real pa
March 1, current year
see �tnctior�r on reverse side)
Key number / legal desuiption I Record
(�
of Mortgage / ContreG debtec
March 1, currenl year
�3, �v7. 3�
If no, what is his / her exacl share of
If name on record is different than that of applicant, indicale
o( mortgagee or contracl
Address of mortgagee or conirad seller
Name of assignee or other owner or holder of mortgage
assignee (number and street, city, state, ZIP
! � IPage
of Is the applicaM the sole legal or
owner? ❑ Yes 0 No
If owned with someone other than spouse, indicate with whom.
city, stafe, ZlP
Does applicant own property in any other I If yes, what county? I What Taxing District?
wunty in Indiana?
Deduction approved
20
Signature
COUNTY AUDITOR
in the amount of:
20 � Fi 20 � 20 20
�� � P
� Couniy Auditor
Is the property in question:
❑ Real Property ❑ Mobile Home QC 67.7-�
aa- yY9
Has this deduction been requested on
property for current year?� Y=s� No
�
Date
20
We certify under the penalty of peryury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner oLtlie atorementioned property on March 7, 20
Person auihorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
authorized person