HomeMy WebLinkAboutMortgage_Elliott (4)a�`�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
fi��� FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
� State Fwm 43709 (R6 / 5-06)
� Presaibed by Oepartrrent of local Gwemment Finarice
INSTRUCTIONS: � � '°' File Mark
To be filed in person o� by mail with the County Auditor of the county whe�e the p�opeRy is�Q�ated.
Frling Dates: 1J Real Property: Dunng the 12 months before ,lune Il of the year the dedua%iFa's �0 6e��live.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch•-2y �o,/the year fhe deduction is to be eilective.
See reverse side for additional instniclions and qualifications. p'/a�. ��
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Applicanl (owner or contract bu r see rest�ctions on �rse s e -
Taxing Distrid Key number / legal description Record number O
V� \ 10 � ` � 7 �OI ��D ' /D� 'W Page number � o [ D
Assessed value of real properfy as of Mortgage / ContreG indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year , - owneR ❑ Yes [] No
t.�
If no, what is his / her exact share of interest? I( owned with someone olher lhan spouse, indicate with whom.
If name on record is diflerent lhan that of applicant, indicate below: Is the property in question:
❑ Real P�operty ❑ Mobile Hane (IC Cr1.1-�
�me of mortgagee or contrad seller �
Address of moRgagee or contraG seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
. , ,� . .
Address of assignee (number and street, city, state. T.�P �^`
l.M1a�........
Does applicant own property in any Dra«'er �`� •� ri�? Has lhis deduction been requested on
county in Indiana? '� �'7 � property for wnenl yeaR � Yes ❑ No
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CardNO��R•� " �
Deduction approved in the amount of:
20� 20�� 20 20 20 20 20
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Signature County Auditor Date
�'� We certiy under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
esidenl of Indiana and owner of the aforementioned property on March 1, 20
Si re (owners full name) � Person authorized by duly executed Power of Attomey
L+ or by IC 6-1.1-12-.07 �
F I resident address of applicant Address of authorized person
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