HomeMy WebLinkAboutMortgage_Elpers (12)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
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� Presaibed by Department ot Loca� Govemment Financa T?.:CA 1�1V
TT��}.} �ry-1� DULY ENT �RED �U� f� ansfer
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INSTRUCTIONS: daY °� —f��-�q�
To be filed in person or 6y mail with the Counry Auditor o/ the county whe2 the R��ertyt i�s �ed. /� Auditor
Filing Dates: 1) Real Property: Dunng the 12 months 6efore May 11 oI the yeapt6e dedUCtr�s [o eHect(ve �� 0 ��bson County
2J Mo6ile Homes assessed under IC 6-1.1-7: Between JanuaEy 15 and March�2 0l the�ie8r(//(7e��cfddcPion,is to be eflective.
See reverse side Ior additional instructions and qual�cations. /��kJ�C��c�" x`
� G!SSO;J COL'\T� AUO;TC•
Applicant ( n orcontract 6uyer- s restrictions on reverse side)
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Ta�cin Distrid Key number / al descrip n Record number �
D D ]�� j� �� r�i1 Page number �
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Asse ed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is lhe appliqnt the sole legal or equitable
March 1, current year March 1, current year owne(? ❑ Yes ❑ No
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate wilh whom.
If name on record is different than that of appliwnl, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
�ame of mortgagee or contrad selier �
Address of mortgagee or contraIX seller (number and stieet, city, state, ZIP
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, whal counry? What Taxing Distrid7 Has this dedudion been requested on
county in Indiana? property for current yea(?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 � 20 � 20 O� 20 b�i 20 20
P � p
Signature County Auditor Date
�'/ We certify under the penalty of perjury that the above and Toregoing information is true and corred and that the applicants was / were
resid 1 of Indiana and owner of the atorementioned property on March 1, 20 '
ign ure (owners full name) Person authorized by duly executed Power of Attomey
(,� or by IC 6-1.1-12-.07
I re dent address of a plipnt Address of authorized person
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