HomeMy WebLinkAboutMortgage_Conrey��� � STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
's' � FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
��«. J StateFOrtn43709 (R6/S-06) �
PreSaibed by Deperiment of Loral Govemmen� Finance
INSTRUCTIONS: F' M� �
To be filed in pe�son o� by mail with lhe CountyAuditor of the county where the property is locafed.
Filing Dates: 1) Real Property: During the 72 monihs 6efore ,lune 17 of the year the deduction is to be e t� e�
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0l lhe year e de uc on is to be eliective.
See reverse side for additional instrucUons and quali(rcations.
NOV 0 S 2006
Applicant(ownerorconfract r-seere rid' ns�erse i �
OUNTY AUDITOR
Taxin ' ri Key number / lega descriptio Record numb
G i9-3-7�( 3a�- 4f=r oa Q
QO('/,1Q O ��� � Page number Q�
�i"
Assessed value of al property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current r March 7, current year ownef? ❑ Yes � No
l3700C�
If no, what is his ! her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than thaf of applicant, indicate below: Is lhe property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
me of mortgagee or contrad seller t
Address of mortgagee or conVact seller (number and street, city, state, Z
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current yeaR � Yes ❑ No
COUNTY AUDITOR
Dedudion approved in the amount of:
20 �'J� 20 20 � 20 20 20 20
P
Signature County Auditor Dale
We certiy under the penalty of perjury lhat the above and foregoing information is true and correct and lhal the applicants was / were
resident of Indiana and owner o( the aforementioned property on March 1, 20
' ature (owne/s full name) Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
sident ad ress of a Address of authorized person
D � •Y�