HomeMy WebLinkAboutMortgage_Ziliak (3)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� �\
�'+ ! State Fwm 43709 (RS I 4-03) � -� 'L� �,
i« - SU �
�� Presaibetl Oy Department ot Local Govemment Finance (�
lI j
�
�asrRUCnon,s: M�Y 19 �;(�1�a,�
To be filed in person or by mail with the County Audifor of the county where the property is located. /�
Filing Dates: 1) Real Property: During fhe 12 months before May 11 oJ the year the deduction is Jo be e/fective. �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ /�h�e-��-y�ear the-deductiofiis e effective.
See reverse side /or additional instructions and qualfications. /' GI°SON COU� i Y^�� �""
Applicani (owner r ontract buyer- see re tndions o verse side) � ' ,
1.1._Q�
Taxing Distrid Key nu ber / legal description Record number
� ��� � � _ o �� (�� Page number � � /
� lD
Assessed value of real properiy as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, wrrent year � 3� � owne(? ❑ Yes ❑ No
S ,Qa� '
If no, whal is his / her exact share of interest? If owned wilh someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is lhe property in question:
❑ Real Property ❑ Mobile Horne QC Cr1.1-�
�ame of mortgagee or conVad seller �
Address of mortgagee or conVact seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, sfate, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? propeAy for current yeaR� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
2o zo �i zo � zo �g 20 0 9 zo zo
P �
Signature County Auditor Date
� I We certiTy under the penaity of perjury that the above and foregoing information is true and corred and that the applicants was / were
f Indiana and owner of the aforementioned property on March 1, 20
ign ure ners f 11 n�ne) � Person authorized by duty executed Power of Attomey '
� or by IC 6-1.1-12-.07
C_
II ident address of ap i nt '/ Address of authorized person
C..!%�T //��.�+ c�t- ��SS/�