HomeMy WebLinkAboutMortgage_Sermersheim�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
•. w� J StateFOrtna3709(R514-03) ' — � _�1 ��
PfescnDeO Ey Depariment o( local Govemment Finance -� � � ,Ii
� ''� ;1 �:� ��/ .•�
� �,,� y-�
INSTRUCTIONS: 5tY '3 (, PZ��lark
To be �led in person or by mail with ihe Counry Auditor of the county where the property is located. � � �
Filing Dates: 1) Real Property: During the 12 months before May 11 0( the year the deduction is to�6e effective.
2) Mobile Homes assessed under IC 6-1.1-7: 8etween January 15 and Ma�ch 2 0! the year the�deductron.is�to�tie'effective.
See reverse side for additional instructions and uali�cations. ,���(Y/ �� �, �"• � y-,
Q / r�.��J' ...i
_ a �- I 4 -6`� - a�Cz �
Applicant (owner r ntract buyer- see restric'io�s on re�verse side)
. �
Distrid
Assessed value oi real property as of
March 1, curtent year
If no, what is his / her exaci share of interest?
name on record is different than that
number / legal
Record
Page number
Mortgage / Coniraci indebtedness unpaid as of Is the applicant the sole iegal or equitable
March 1, current year owne(? ❑ Yes ❑ No
indicale befow:
� ��Oba I
If owned with someone other lhan spouse, indicale with whom.
�me of mortgagee or contrad seiler
CJ�� � V
Address of mortgagee or wntrad seiler (number and street, city, state, ZIP
i--- _ .. .,--�-�_
Name of assignee or other owner'vr holder � D�_
� , /�
assignee (num6erand st2ef,
Does applicant own property in any other
county in Indiana? ;
r ` �
{ •
Deduction approved in the amounl of:
20 � I 20 ��
❑ Real
lL 7 U �
� � ���.
20 � 20 � 20 _
County Auditor
S�'
��l/j ��Q. �a+
20
Date
❑ Mobile H«ne QC 61.
ion been requested on
rent year?� Yes❑ No
20
certiry under the penalry of perjury that the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
executed Power of Attomey
or by IC 6-1.1-12-.07
of applicant `� n �Address of authorized person