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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State F«m a37os (Ra i ia-o7)
Prescri�eC Dy Departmenl o/ Laal Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county wheie the property is located. Md 1 � 2003 f
Filing Dates: 1 J Real Propedy: Dunng (he 12 months before May 11 0l the year the deduction is l0 6e er1'eRtiv�.
2) Mobife Homes assessed under IC El.l-7: Behveen January 15 and March 31 o//l�the year the deduction is to be effective.
See reverse side !or additional instructions and quafifrcations. ,t����j �,_/� /��
:!BSOrJ COiihTV A��DITOP
Applicanl (owneror n ct b e- res ctio o reverse side)
Tauing islrid Key number / legal description Record number D�
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1 Kurrent year �3 �� owneR ❑ Yes ❑ No �
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If no, whal is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Propeity O Mobile Home pC 61.1-�
�3me of mortgagee or contrad seller
Address of mortgagee or contract seller (number and st2et, city, stat , ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant awn property in any other If yes, what county? What Taxing District? Has this deduclion been requested on
county in Indiana? property for current year? � Yes 0 No
COUNTY AUDITOR
Deduction approved in the amounl of:
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Signature County Auditor Date
�/ We ceAify under lhe penalty of perjury lhat the above and foregoing infortnation is true and corred and that the applicants was / were
�lesident of Indiana and owner of the aforementioned property on March 1, 20
Si re ners 11 e) Person authorized by duty executed Power of Attomey
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F I resid n address o appli t Address of authorized person
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