HomeMy WebLinkAboutMortgage_Dooleye`pR�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-• i+4" : FOR DEDUCTION FROM ASSESSED VALUATION
\'� � � State Form a37os (Ra 1 7o-ot)
� Prescribe0 by Departnent ot Local Govemment Finance
Year
� p'--1
INSTRUCTIONS: � �• • e Mark
To be filed in person or by mail wifh the County Audifor of the county wheie the prope is lac te .
Filing Dates: 1) Real Property: During the 12 months before May 11 of lhe yea� the deductio�1i¢, (Q� e/fe�a�
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 3 f'b�the�year the deduction is to 6e effective.
See reverse side (or additional instructions and qualifications. /'` � � �% �
Applicant (owner or cyrtf�ac}� buyer- see
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As essed value of real property as of
Marcn 1, wrrenf year
If no, what is his / her exact share of interest?
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Key number / legal description � � Record number
D/� �/�n��i— D� Page number v O�/
V(/(�/ /
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year � S O � � owne(? ❑ Yes ❑ No
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If owned with someone other than spouse, indicate with whom.
If name on record is different than lhat of applicant, indicate
of mortgagee or contraU seiler
ot mortgagee or contrad seller (number and st2et, city, state, ZIP
assignee or other owner or holder of mortgage
Address of assignee (number and st�eet, city, state, ZIP
Does applicant own property in any other If yes, what county? What Taxing District?
county in Indiana?
Deduction approved in the amount of:
20 0.3 20 0 20
���
SignaWre
COUNTY AUDITOR
20 Ue � 20
�
County Auditor
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s the property in questfan:
❑ Real Property ❑ Mobile Home QC 61.1-�
Has this deduction been requested on
property for current year? 0 Yes � No
20 ��
Date
20 O �!
� We certify under the penalty of perjury that the above and foregoing information is true and corred and that lhe applicants was / were
resident of Indiana and owner of the aforementioned propeRy on March 1, 20
Person authurized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
iress ot applfcant � Address of authorized person
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