HomeMy WebLinkAboutMortgage_Helsley�,�� 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
's• = FOR DEDUCTION FROM ASSESSED VALUATION �7—Co�uyyynt Township Year
�y State Fwm 43709 (R6 / 5-06) � � � �
�M• Presrnbed by Department of Loml Govemment Finance
INSTRUCTIONS: FEB 1 FiI�W1`aiic
To 6e filed in person or by mail with the CountyAuditor of the county where the p�operty is locafed. ,^
Filing Dates: 1J Rea/ Property: During the 12 months before June Il of the year the deduction is to be efl ,i�
2J Mobile Homes assessed under IC 6-i. i-7: Between January 15 and March 2 o(the���r�tae�d UNTY�AUDITOReffective.
See �everse side for additional instruc6ons and qual�catlons.
Applicant (owne� or cont ct uyer= see restn 'ons on reverse sid
Tauing Distrid Key number / lega description Record number ��
C li ��i��l/I'V"` � l� �l �-�—� �-�J03—OO(�. S( a���er L-% 0�0 0
Assessed value of real property s f MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
MarcF� 1, wrtent year March 1, curtent year owneR ❑ Yes ❑ No
3 S c�
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is dif(erent than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mod1e Home (IC 61.1-�
ne of mortgagee or contraG seller
Address of mortgagee ar contrad seller (number and treet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code) .
Does applipnt own property in any other If yes, what county? What Taxing Dislrict? Has this dedudion been requested on
county in Indiana? property for curtent year? � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20�_ 20 20 20 20 20 20
P P
Signature County Auditor Date
We certiy under ihe penalty of perjury thai the above and foregoing informalion is true and corred and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owner (ull name Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
Full resident a ress of app icani Address of authorized person
� . �_ � i .
,l/1.�✓
-----------------------------------------------