HomeMy WebLinkAboutMortgage_Hall (4)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Yea
�1 M / SiatB Fwm 03709 (R5 / 4-03)
� PresaiDed by Department of Local Govemment Finance '
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INSTRUCTIONS: � File Mark-✓
To 6e �led in person or 6y mail witA the County Auditor o( the county where the property is located. FEB 1 3 2��4
Filing Dafes: 1) Real Property: During the 12 months belore May 11 0/ the year the deduction is to be eNective.
2) Mobile Homes assessed under lC 6-1.1J: Between January 15 and March 2 0/ the yea� the deduction i�o be eRective.
See reverse side for additional instructions and qualifications. �� �,� ,1 %/ /J
'� �_ I ' � " V V � a�O� 5SON C�OUY7 Y UDI70R
Applicant (ow � or contract buyer- se tri� n on 2verse side) n^
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Taxing Distrid Key number / legal description Record number ��
1/!�C �n �� 6o q 8a �O� Page number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owne(? ❑ Yes ❑ No
50
If no, what is his / her exad share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicanl, indicate below: Is the property in question:
❑ Real Property p Mobile Home QC 61.1-�
�me of mortgagee or conVad seiler 1
W
Address of moAgagee or contrad seller (number and street, city, stafe, ZIP
Name of assignee or other owner or holder of mortgage
� 2
Address of assignee (number and streef, city, state, ZIP code) 6 7_ q a�
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requesled on
county in Indiana? property for current yeaR 0 Yes � No
COUNTY AUDITOR �
Deduction approved in fhe amount of:
20 8y� 20 b�0 20 �/ U 20 20 � 20 20
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Signature County Auditor Date
'/ We rtify under the penalty of perjury tha[ the above and toregoing infortnation is lrue and corred and that lhe applicants was / were
res' ent of Indiana and owner of the aforementioned property on March 1, 20
ig a re (owner's (ull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Fu esident addre s of applicant Address of authorized person
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