HomeMy WebLinkAboutMortgage_Meyer� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS • � � � � `�
FOR DEDUCTION FROM ASSESSED VALUATION o6n � i own'shipo Year
�� / Sufe Fwm E3109 (RS / a-03) � n
� '«. 2�'JT
Prescdbed by Depariment of Local G6vemment finance MAR 9
INSTRUCTIONS: 'BS O C�r le up TQR
To be filed in person or by mail with the County Auditor o( the county where the property is located
Filing Dates: 1) Real PropeRy: During the 12 months be%re May 11 0l the year the deduction is to�e etfective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the year the deduction is to 6e effective.
See reverse side (or additional instructions and qualifications.
Applicant (owner or contracf 6uyer - see restnctions on reverse side)
�M CD� (�
Taxing
Assessed value of reat property as
March 1, wrtent year
If no, what is his / her exact share of interest?
Key number / legal description Record number
7�(o.-/Y-/9-/0/ -00%306- 007
� Page number
Q1 �� ' ,
MoAgage / Conlred indebtedness unpaid as of is the appticant
March 1, current year owner? I
..:� '�
�� legal or equitable
❑ No
� �, �
If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate betow:
of mortgagee or contract seller '
Address o mortgagee or contred selle (number and street, city, state, ZIP
Name of assignee or olher, owner or holder of mortgage
assignee (number and st2et, city, state, ZlP code)
Does applicant own property in any other � If yes, what couny?
county in Indiana?
Deduction approved in lhe amount of:
20 20.0� 20 0�
P P �
SignaWre
Is the property
❑ Mobile Home QC 61.1-�
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�o a��........ —
�ra���cr i �
What Ta; "� , � �Q ed on
�C�di ',�...;•"'..V „n„ � ❑No
.� a.OtV� :V�j��
d I -+" `
COUNTY AUDITOR
20
County Auditor
20
20
Date
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
(ull
�,ident address of
4 a � c,v..
Person authorized by duly executed Power of Attomey
or by IC 6-t.t-12-.07 '
of authorized person