HomeMy WebLinkAboutMortgage_Egdorfe`°R�" t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
n`° _: FOR DEDUCTION FROM ASSESSED VALUATION
S�y Sute Form a3�oe (aa i io-oi�
�� Prescribed by DepartmeN of Local Govemmem Finance
INSTRUCTIONS:
Coun Township Year
File Mark
To be filed in person or by mail with fhe County Auditor oJ the county whe2 the property is located.
Filing Dates: 1) Real Property: During the 12 months 6e7o�e May 11 of the year the deduction is to be eflective�
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ the'year the deductio,n is to�IbIe e/H/ective.
See reverse srde (or additional insWctions and qualifications. L� ��� J=-�'
CCR 1 1 0�2
Applicant (owner contract buyer - see restri ' n on reverse side) ;� '` n
�� C70� � /�E�tl d` . J�/f-r/n/ c � � � , � , .�Q��
Taxing Disirid Key number / legal description Record numtie�,,, ��"(.v �;;�;'C� �+
�� C�.,��U�.� .. ..
��(�4.i,� C'� (.�t O�/' � U �!l .7 ^ B U Page number a Y �
�0
Assessed value of real property a of MoAgage / Contract indebtedness unpaid as of Is the applicant the sole I gal or equitable
March 1, current year March 1, current year owner? [�'�s ❑ No
yo�-�
Ii no, what is his / her exact share of interest? If owned with someone olher than spouse, indicate with whom.
I( name on record is different Ihan that of applicant, indicate below: Is the property in question:
L�Real Property ❑ Mobile Home QC 67.1-�
��ne of mortgagee or contrad se /
✓�'! (�,lcif2 / � JL / C �T � �
Address of morigagee or contrad seller (number and street, city, state, ZIP
319Y
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for wrrent year? � Yes 0 No
COUNTY AUDITOR
Deduction approved in the amount of:
zo���,ll Zo� zo� zo� zo�� zo 07 20_�
�-�o-P� � P P
Si ature County Auditor Date
�
i� We certify under the penalty of peryury that the above and foregoing information is true and correci and lhat ihe applicants was / were
�ident of Indiana and owner of the aforementioned property on March 1, 20
Signat ow /s (ull narpe) Person authorized by duly executed Power of Aftomey
� �� or by IC 6-1.1-12-.07
_ F I restdent address of applica Address of authorized person
/3v � ... Y ,