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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
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� Prescn�etl by Departmem of Local Govemmeni Finance
:�... �►�: ��
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INSTRUCTIONS: � . File Mark �
To be /iled in person or by mail with the County Auditor o( the county where the property is located. �p-y��r,a� ,(���+!���
Filing Dates: 1) Real Property: During the 12 months before May 11 0! the year the deduction is to 6e efiective;J v
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the(yL§?QR�rd@i�t%c�i�rils (oTbe eNective.
See reverse side (or additional instructions and quali�cations.
buyer
Taxing
on reverse s/tl�1 . �
Key number / legal description � I Record number n', O�
/��J
� � / Q O/� ` /y-� q�/ "�� Page number� „ ��
Cy c,ti / o w �S
Assessed value of reat property as o Mortgage ! ContraU indebtedness unpaid as of Is ihe applicant the sole legal or equitable
March 1, wrrent year March 1, current year owner? ❑ Yes ❑ No
If no, whaf is his / her exact share
If name on record is different than that of applicant,
of mortgagee or contrad seller
Address of morigagee or contract
Name of assignee or
Address
owner or holder of mortgage
(numberand street, city, sfate, ZIP
If owned with
below:
�
city, state,'ZIP
other than.spouse, indicate with whom.
A the pr
� Real
Does applicant own property in any other �f yes, what county? What Taxing r�
county in Indiana? n �
I
��� � , , 3
Deduction approved in fhe amount of: .1N- �� U
�a � �
zo�� zo o� Zo 6 2o zo_
;� P P I
Signature
County Audilor
Date
❑ Mobile Home pC 61.1
'on been requested on
�t year? � YesO No
zo
We certify under the penalty of perjury that the above and foregoing in(ormation is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
(owners full
Person authorized by
or by IC 6-1.1-12-.07
resident address of apAlicant {' IAddress of authorized person
Attomey