HomeMy WebLinkAboutMortgage_Green (2)� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
-° � FOR DEDUCTION FROM ASSESSED VALUATION _ Townsh Year
t tt--
�,�� �� � Slate Fortn 43709 (R4 / 70-Ot) ' � �
�«.
�Presoibed by DeDartment W La;al Govemment Finarxe
_ .ia�v. � 7 2003
INSTRUCTIONS: F/il[e Mark
To be filed in person or by mail wifh the County Auditor of the county whe2 the property is locat��e�eff�ct� y'L
Filing Dates: 1) Real PropeRy: Dunng the 12 monfhs belo2 May 11 0l the year the deduction is e;�q'CI-�
2) Mo6ile Homes assessed under IC &1 J-7: Behveen January 15 and March 31 of tl%'�ye�}fl%=deduetiomisFto`be el/ective.
See reverse side /or additional inshuctions and qualifica6ons.
Applica wner or contract buye - ee restrictions on reve side)
Taxing Distrid Key number / legal description Record number Q�
������q3_6� Pagenumber /� �
/
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, currenl year owneR ❑ Yes ❑ No
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 diflerent than that of applicant, indicate below: Is lhe property in question:
❑ Real Property ❑ Mobile Home pC 61.1-�
�me of mortgagee or contract seller
Address of mortgagee or conVact seller (number and stieet, city, state, IP
�
Name of assignee or other owner or holder of mortgage
n — /G
Address of assignee (num6erand st�eet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for curtent year? � Yes� No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 20 � 20 ,�_ 20 �� 20 �� 20 20
P P
Signature County Auditor Date
'/ We certify under lhe penalty of perjury that the above and foregoing infortnation is true and correct and lhal the applicants was / were
� resident of Indiana and owner of the aforemenlioned property on March 1, 20
Signatur o e/s full name) Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
F nt address of appliqnt Address of authorized person
/ma� � �
9r� 5���0 .o