HomeMy WebLinkAboutMortgage_Thomsonro� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
` ' FOR DEDUCTION FROM ASSESSED VALUATION
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PraunDetl by Depanment oi Local Govemment Finance
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INSTRUCTIONS: � ' �T '
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� To be filed in person or by mail with the County Auditor of the county where the propeKy is located. �� i
Filing Dates: 1) Real Property: Dunng the 12 months be%re May 11 0l the year the deduction is to be eflecti �:
2) Mobile Homes assessed under IC 6-1.1 J: Between January 15 and March 2 0/ the year the deduction is to be eflective.
See reverse side /or additional instructions and qualifications. 5 E P 2 � 2��5
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Applicant (owner or contracf 6i see restrict n on reverse
Taxing Distrid
Assessed vatue of real property as of
March 1, currenl year
If no, what is his / her exact share of interest?
Key number! legal description
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Mortgage / Contract indebtedness unpaid
March 1, current year
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vlBSppi COUNTY
Record number OC
Page number /n �
7
as of Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
Ii owned with someone other than spouse, indicate with whom.
If name on record is different Ihan that of applicant, indicate below:
�me of mortgagee oc contrad seller
Address of mortgagee or contract seller (number and stree ity, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and stree� �c `'� �J� Y` � S
...7
Does appliwnt own property in any other I�^
county in Indiana? D�_� � �
20
Signature
approved in the amount of:
20 � � 2C
s the property
❑ Real Property ❑ Mobile Hane (IC 61.1-�
Has this deduction been requested on
property for current year?Q Yes� No
�
20
We ceAify under the penalty of perjury that the above and foregoing information is We and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
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Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
1 adtlress of applicant Address o( authorized person
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