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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION
•;�� ! suce F«m a3�oy �rts i a��
� Pfescribed Dy Depanment of loral Govemment finaxe
INSTRUCTIONS: Fi M
To be filed in person or by mail with !he County Auditor of the county whe2 the property is locate . ��
Filing Oates: 1J Real Property: During the 12 months before May 11 of the year the deduction is to flective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of th��ra�jd��on is to be effective.
See reverse side for additional instructions and quali�cations. �-y,,
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buyer - see resMc
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Assessed value of real property as of
March 1, wrrent year
If no, what is his / her exacl share of interest?
on
Key nuryber / legal description
✓
6Q3�/ 3og- ,
Mortgage / Contrad indebtedn
March 1, current year
T� Record number
� o�OC� .7
Page number
a3
unpaid as of Is the applipntttt ���the sole legal or
owneR �oYes ❑ No
/
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If owned with someone other than spouse, indicate with whom.
If name on record is diNerent than ihat of applicanl, indicate below:
'3me of mortgagee or contract seller
G/��C
Address of mongagee or con[rad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (number and st2et, city, state, ZIP
Does applipnt own property in any other ( If yes, what counry? Wha,
county in Indiana?
approved in the amount of:
20 _Q �
r�
Is the property in ques6on:
❑ Real Property ❑ Mobiie Home pC 61.
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Card lvo. y a � ..
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COUNTY AUDITOR
20 �� 20 �g_ 20 20
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County Auditor
20
Date
20
�
�ested on
Yes � No
the p� of p'ury that the above and foregoing information is true and corred and tnat the applicants was / were
a an o ner o e aforementioned property on March 1, 20
ull am�j Person authorized by duty executed Power of Attomey
/� //{� or by IC 6-1.1-12-.07
Full resi8'znt addr¢�s ofapplicalA �� IAddress of authorized person