HomeMy WebLinkAboutMortgage_Masters�'�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
''� FOR DEDUCTION FROM ASSESSED VALUATION
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� Prescribetl Dy �epaNrent u( La-al Gcvemment Finance �^ i
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INSTRUCTIONS: � /
Coun Township Year
File Mark
To be filed in person or by mail with the County Auditor o( the county whe2 the property is located.
Filing Dates: 1) Real Property: During the 12 months befo2 May 11 0l the year the deduction is to be eflecfive.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ the year the deducfion is to be effective.
See 2verse side tor additional instructions and quali�ca6ons.
Applicant ( wne� or contract buy - see strictions on rev rse side)
Taxing isinct Key number / legal description Record number �
' /� � DO /'� Pagenumber �
Assessed value of re roperty as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curteni year March 1, current year owne(? ❑ Yes ❑ No
yl
Ii no, what is his / her exact share of interesi? If owned with someone other than spouse, indicate with whom.
—5'� 9 7
If name on record is different than that of applicant, indicate below: Is lhe roperty inq u sti �
Q��"b15�
❑ Real Property LJ Mobile Horrie QC &1.1-�
�me of mortgagee or contract seller ,
Address of moRgagee or contrad selier (number and st2et, city, te, ZIP �
Name of assignee or other owner or holder oi mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Tazing District? Has this deduction been requested o�
county in Indiana? property for curtent year? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 20 h_r 20 /� 6 20 �� 20 �g_ 20 �� 20
�k8a� ,9' � � P
Signature County Auditor Date
�/ We certify under the penalty of perjury thal lhe above and foregoing information is true and correct and that the applicants was / were
e residenl of Indiana and owner of the aforementioned property on March 1, 20
Signatu ( vner lull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full resident a ress o pplicant Address of authorized person