HomeMy WebLinkAboutMortgage_Dupps (2)`° �"° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-- = FOR DEDUCTION FROM ASSESSED VALUATION
�. - � State Forrt143709 (Ra / 70-07) ' .
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� Presaibed hy Depariment W Loral Govemment Finance
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INSTRUCTIONS: �"'� y+Fil
To be filed in person or by mail with the County Auditor of the county where the propeRy is loca� ��
Filing Dates: 1) Real Property: During the 12 months be7o2 May 11 of the year the deduction i be eNective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0/ the ye�a�e�u�op3is to 6e
See ieverse side /or additional instructions and qualifica6ons.
Applicant (owner or c�ract buyer- see
Taxing Distrid
Assessed value ofre�
March 1, current year
side)
Key number / legal description
G�ggpN
Record number /(� (1
v o�
Q/ �� �O r� '— Pagenumber Gj�s r.
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as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current,year ownef? ❑ Yes ❑ No
I ii. :n .. _
If no, what is his / her exact 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 the property in question:
❑ Real Prope�rty ❑ Mobile Home (IC 61.
lame of mortgagee or contrad seller
c� n �
Address of mortgagee or conVact seller (number and stieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applipnt own property in any other If yes, what counry? What Taxing Distrid? Has this dedudion been requested on
county in indiana? property for wnent year? �] Yes ❑ No
Deduction approved in the amount of:
20 //, 20
tw""
Signature
� / We certify under the
�•resident of India�
COUNTY AUDITOR
20 h�{� I 20 �
County Auditor
20 �� � 20
�
20
of Perjury that the above and foregoing information is true and corred and that the applicants was / were
� of the aforementioned property on March 1, 20
Person authorized by duly execuled Power of Attorney
or by IC 6-1.1-12-.07
ofauthorized person