HomeMy WebLinkAboutMortgage_Clark� "
STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VAWATION Coun 7ownship _ Year
�+ M / Siate Fortn 43709 (R5 / 4-03) � `, � ± ..� i� t� �
�L+
� Ptes<riDetl Dy DepartmeM of locat Govemment Finance � `-yr
iNSrRUCrioNS: MARF.ie �a�004
To be filed in person oi 6y mail with fhe County Auditor ol the county whe2 the property is located. �` /J
Filing Dates: 1) Real Property: During the 12 months belore May 11 0/ the year the deduction is to be e�ctive. �,� �,�„a,16�
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the yea'r,�!/ie4deduction, is;to 6e efleclive.
. b:�av:v -. �
See reverse side for additional instructions and qualifications.
Applicant (owner or
Taxing District
side)
y number / legal description � Record number
n y yj1 „ / .. J1sf �/� D/� —� � �J ✓ � Page number / �'��/
�C./l_6ULC(� .<L,I'c��� Of 0 � �r—
Assessed value of real property as of Mortgage / Contred indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, cunent year March 1, current year owneR ❑ Yes ❑ No
If no, what is his / her exact share
If name on record is different than that of appiicant, in
�me of mortgagee or contrad seller ��
Address of mortgagee or contrad seller (number and
Name of assignee or other owner or holder ot mortgage
assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what wunty?
county in Indiana?
Deduction
�
Signalure
ihe amount of:
20 A [o I 20
owned with someone olher lhan spouse, indicate with whom.
state, ZIP
COUNTY AUDITOR
20 �&
- P
County Auditor
Is the property in question:
D�Real Property ❑ Mobile Home (IC 61.
Dra�r�er NO ...................
C81'd NQ. ..� .,( J� , �uested on
������ 7Yes❑No
20 � 20 _
�
Date
20
We certify under the penalty of peryury that the above and foregoing information is true and correct and that ihe applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20 �
� �
resi ent address of app icant
S�� (�v_ Cbwv�G Sf . Flli�Ssf��rl �/ V
Person authorized by duly executed Power of Atlomey
or by IC 6-1.1-12-.07
of aulhorized person