HomeMy WebLinkAboutMortgage_JohnsonSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION 'Geun r-- Tottt1wn1ship.� Year
�. �w� I Siate Fwm 43709 (RS / 4-03) � � �
� PrescriEed by Departmem of loral Govemment Finance
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INSTRUCTIONS: �' File Mark
To be filed in person or 6y mail wilh !he County Auditor of the county whe�e the property is located.�
Filing Dates: 1J Real Property: Dunng the 12 months 6efore May 11 o/the year the deduction is to`'�bg"ef�ecti�J��-�
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0/ the year'me deductionfis�foTbe'eNective.
See reverse side lor additional instnictions and qualifrcations.
- � $-103 0� 'i�`'f' ' �0�
Applicant �ner or contract b y - s restrictions on reverse side)
Taxing ' rid Key number / legal description Record number O
�)� _ ��./��� � Page number �^� �
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Assessed value of real property as o MoAgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, current year � ownef.� ❑ Yes ❑ No
�
If no, what is his / her exad share of interest? f owned with someone other ihan spouse, indicate with whom.
If name on record is different lhan lhat of applicant, indicate below: Is the property in question:
❑ Real Properiy ❑ Mobile Home (IC 61.1-�
�ame of moRgagee or contrad seller �
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand stieet, city, state, ZlPcode) D/_ ,!��
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Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signature County Auditor Date
��/ We certity under the penalry of perjury that the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Sign r(owners (ull na e Person authorized by duly executed Power oTAttomey
-� � or by IC 6-1.1-12-.07
Full y denl ad ess of licant Address of authorized person
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