HomeMy WebLinkAboutMortgage_Rostron`�'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION C � 7o s ip Year
'• ���M -/ StateFwma3709�RS14-03)
� ' PrespiC¢d by Department of Local Cwvemment Finance .
�
INSTRUCTIONS: �y,, File M�
To be (led in person or by mail with the County Auditor o/ the county where the property is located. ���R� '�
Filing Dates: 1J�Real Property: Dunng the 12 months belore May 11 0l the year the deduction is to b��@Ctiv�pUNTY AUDITOR
2) Mobile Homes.assessed under IC 6-1.1-7: Between January 75 and March 2 0/ the year the deduction is to be eflective.
See reversesrde for additional instructions and qualifications. '
or contract
¢ �
Taxing
see 2smcnons on
Assessed value of real property as of
March 1, wrtent year
if no, what is his / her exact share of interest?
If name on record is different ihan that
oi mortgagee or contract seller
A�ddress of mortgagee or contYact seller
Key number / legal description
d l 3-Cd
Mortgage / ContraG ind�
March 1, current year
indicate below:
Name of assignee or other owner or holder of mortgage
Record number
Page number
'-�a 50
,
unpaid as of Is the applip the sole legal or
owner? s� ❑ No
If owned with someone other than spouse, indicate with whom.
city, state,
Address of assignee (number and street, city, sfate, ZIP code)
Does applicant own property in any other If yes, what county?
county.in Indiana7
Deduction'approved in lhe amounf of:
�
�
Signature
zo �$_
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Is the property
❑ Mobile Home (IC 61.
a�b�s~ -
DrawerNO :..................
�n �jQ Jr" W
Card �t0. •••••
................
8��iia5 �3D,00�
couNrY a�
zo � 20�
County Auditor
zo
Dale
20
�estetl on
Yes � No
' We certify under the penalty of perjury that lhe above and toregoing information is true and correci and that lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
sitlegYatltlress of applicant � Address of authorized person
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