HomeMy WebLinkAboutMortgage_Dewig (7)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION C n Township Year
.� ��jjyy J State Fwm 43709 (RS / a-03) '
M PrescriOed by Department ot Local Govemment Finance
INSTRUCTIONS: i ark��■--.;
To 6e filed in person or by mail with the County Auditor o/ the county whe2 the propeRy is located. �-�j �
Filing Dates: 1 J Rea/ Property: During the 12 months belore May 11 of the year the deduction is to be efl 've. � B...J
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be eHective.
See reverse side for additional instructions and qualifications. � JA N 3 1 2005
Applicant (ownerorconfract buyer-
Taxing
►
Ass�'ssed value of real property as of
March i, curtent year
If no, what is his / her exacl share of interest?
tions on r e sitle
Key mber/lega descr tion
(3-6�0��-� C
Mortgage / ContraU indebtedness unpaid as
March 1, curren ea��O O
name on record is different than ihat of applicanl, indicate below:
of mortgagee or wntraIX seller
Address of mortgagee or contrad seller (number and street, cify,
or other owner or holder of mortgage
of assignee (number and street, city, state, ZIP code)
Does applicant own property in any olher I If yes, what counry?
county in Indiana?
Deduction approved in the amount of:
20 �7
Signature
Record number
number
Is the applicant the sole legal or
owner? ❑ Yes ❑ No
If owned with someone other than spouse, indicate wilh whom.
s ihe property fn question:
❑ Real Property ❑ Mobile Home QC 61.
ZIP
What Taxing District? Has this deduction been requested on
property for wrrent year?0 Yes� No
COUNTY AUDITOR
20 � I 20 � I 20 � 20
- County Auditor
20
Date
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and thai the applicants was / were
�esidenl of Indiana and owner of lhe aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
person
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