HomeMy WebLinkAboutMortgage_Hannah� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
` ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
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• Prescn�etl Ey Department of Locai Govemment Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor o/ the county where the property is located. 7�""'1�{ `f �--�
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Filing Dates: 1 J Real Property: During the 12 months be%re May 11 oJ the year the deduction is to be ejfectiire. � J,�� ��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yea�the ded ction i"s to e effective.
See reverse side !or additional instructions and qualifications.
JAN n2 2004
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Applicant (owneror contract buy r ee tdctions on v se side) ' ��J,���
" GiB� J�4 COUTITY AUDITOR
Taxing D' t� Key number / legal de iption Re rd number O
, O 0 Q f� O^ O P ge number
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Assessed vatue of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applica i the so e legal or equitable
March 1, curcent year March 1, current ear owneft ❑ Yes' ❑ No
. �s-a s�
If no, what is his / her exact share of interest? If owned with some other than spouse, indicate with whom.
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If name on record is different than tFiat of applicant, indicate below: Is lhe property in quesGon:
❑ Real Property ❑ Mobile Home (IC fr1.1-�
�me of mortgagee or contract seller
Address of mortgagee or contraIX seller (number and s�eet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applipnt own property in any other If yes, what counry? What Taxing District? Has this deduction been requested on
county in Indiana? property for wrtent year? 0 YesO No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signature County Auditor Date
��/ We certify under the penalty of perjury lhat lhe above and foregoing information is true and corred and that ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signat re (owners full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ull esident address f applican Address of authorized person