HomeMy WebLinkAboutMortgage_Rodocker°"� STAIEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
FOR DEDUCTION FROM ASSESSED VALUATION a
sa+e F«,� a3�as �r� i 20�� �
�° ,,,, � Presmbed by DepaMient of Local Go�emmenl Finanra
File ark
INS7RUCTIONS:
To be (!ed in person or by mad wdh the CountyAUditor of the courrty where the p/operty is located. O V � 7 1 �(��f
Wing Dates: 1) Real Propei(y: During the 12 months belore June 11 0! the year fhe deduction is to be eNective.
2) Mobile Hames assessed under IC 6-1.7-7: Behveen Janvary 15 and March 2 0/ Ure year the de�clim is�be effecSve.
See ieverse side !or additional insWCtions arM quali�cations. l� ���i �c-�, �
GIB �� �
nvdirannlowneraroGntradhuver-seere mretersesideli DITOR
Ke nimber/lega
0 6-/
popaly as of Mard� 1. ttrrenl Year
or �mere:n
recwd is d"dferant than ihat of applican4 indiole below:
irWebtedness unpaid as
' DOG
Nartre af rtarigagea ar cmlracl seller
3
Address of rtarlgagee a conlracl seller (number aiW .Ciae(, tity, stafe. aM ZIP code)
Nartre ot assi9rree a oU�er owner rn hdder of matgage
Adtlrea of assi9rree (rncMet and sGeef. dfY. 9ate. and
Does epplicarG oxn prapertY in arry dher
couNy m Indiaria?
❑Yes ONo
Deduction approved in the amwnt of:
20 20
P
SigraWre of Counry fwdMr
If yes. what counry? I What Ta�dn9 DisUic
COUNTYAUDROR
20 20 20
I ��a
Rewrd number Page rwmber
aa� Fr `��//
is u,e a�cm,t u� saa ieyai « eyaiawe �n
❑ Yes � No
spouse. indicate wilh whom.
Is Ihe property in questlan:
�I ProoerN ❑ Modle Home OC 61.1
20
uested o� propeny
❑Yes ❑ No
20
i/ We cerUfy under the penalty of perjury tliat tlie above and fwegoing infortnatbn is true and corted and tliat the app6nnts was / were a resident of
Indiana and owner of the afwementioned property on March 1, 20
Dale man(h,OaYY��)
vmf�me lrnma/s fill namel i
address of appliranl (nwMU an0 s6ee1 cily. state.
/V
or by IC 61.7-12-.07
persni (number aM stree7, cCy, stafe, and
Date (monN, day yean