HomeMy WebLinkAboutMortgage_Moers.� °� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDI
FOR DEDUCTION FROM ASSESSED VALUATION
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INSTRUCTIONS:
To be filed in person or by mad with the CourttyAuditor o/ the counfy where the prope`ty is bcated. /��!�
Fding Dates: i) Real Roperty: Dunng fhe 12 months be/ae Jwe 77 of the yeai the deducSon is fo be e/(ective. _• B� �+�{
2f Mo6de Hames assessed urMer fC 61.7-7: BeAreen January 15 and March 2 of fhe year fhe deduction is to be e9eclGk ~(J
See reverse side /or additional ins6uctions arid qualifications. C���80N COUNTY AUDITOR
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1 re� property as of Mamh 1. anetq yeer Martgage I ConVaG indebtedness unpaid as of March 1, Is ihe appG�anl lha sde legal a equitaMe wmall
wrtan year
��O 5%:� ❑Yes �No
/ het exacl share of inteiesY± If m.�ned with someone alher Ihan spouse. indicate wilh whom.
If reme m recartl is different Ihan Ihat of �
Name of morigagee or canVact seller �
Address of mo�agce a mnttaa selter (r
Nartre of assgriee a alher owner a hd�
Address of assignee (ixmiber aM sfreet.
Daes epplicant own paperty in any other
couNy in Indiarel
❑Yes ❑ No
Deduciion appmved in lhe amauN of:
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SynaWre of Counry Auditor
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COUNTYAUDROR
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Is ihe prope�ly in quastim:
❑ Real Ptoperty ❑ Molnle Hane QC G1.1-7) �
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Has Ihis deduction bee� requested on nmcertv _-- _
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I/ We cer6(y under the penalry of perjury ihat ihe above and foregoing infortnation is We and correct and ihat the appiinnts was / were a resident of
Indiana and owner oi the aforementioned property o� March 1, 20
Signature (o�vne/s MI nertre) Date (rtanN. OaY. Y��1
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F�/a!dent address ot aqdi�arrt (number antl streef. dty. state, aM ZIP" m�de) -7
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Person aulhorized bY duh ��+ted Power oflLLtanrey w by 1 61.1-12-.07 Oate (rtanfh. Oay, yea�
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