HomeMy WebLinkAboutMortgage_Rowert'" STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' : FOR DEDUCTION FROM ASSESSED VALUATION -• n 1 To��wnyshi , Year
ti - J. S�ale Fortn 43709 (R4 / 10-01) . . ki ',
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� PrescribeC by Depanmenl ol Local Govemment Finance
INSTRUCTIONS: File'Mark
To be filed in person or by mail with the County Auditor o/ fhe county wheie the property is located.
Filing Dates: 1) Real Property: During lhe 12 months befo2 May 11 of the year the deduction is lo �enech�� �� i Y r.UD1T0'
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0( fhe yeaP the ded�uction is to 6e effective.
See reverse side lor additional instructions and qualifications.
� Applicant (owner or contract buyer- see restrictions on rev se side)
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Taxing Distrid Key number! legal description ecord number
O — Q�^I — QO Page number ��
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Assessed value of real property as of Mortgage / Contred indebtedness unpaid as of Is the applicant�sole legal or equitable
March 1, wrtent year March 1, current year ownef? es ❑ No
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If no, what is his / her exact share of interest? If owned wilh someane other than spouse, indicate with whom.
If name on record is diHerent ihan that of applicant, indicate befow: Is the property in question:
eal Property ❑ Mobile Home (IC 61.1-�
�e of mortgagee or contrad seller
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Address of mortgagee or contract seller (number and street, city, state, ZIP o a- 9 iss
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Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Dces applicant own property in any other If yes, what counry? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for wrrent year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
0 20 O 20 b,t' 20 � 20 O� 20 �� 20 �
�T14.t3o� � P
Signalure County Auditor Date
'/ We certify under the penalty of perjury that the above and foregoing informalion is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1. 20
Signature w ers lull na ) Person authorized by duly executed Power of Attorney
! or by IC 6-1.1-12-.07
7
Fuli si ent address of applicant Address of authorized person
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