HomeMy WebLinkAboutMortgage_Null•��A STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`' �'� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
w� ! Scate Fom, 63I09 (RS I4-03)
Prescri�ed trj Departmeni of Loral Govemment Finance
� (� r G, u , Vj '1
INSTRUCTIONS: �Ji �7 (.t Filte Ma�'
To be filed in person or by mail with the Counry Auditor of Ihe county where the property is locatedr ��
Filing Dates: 1) Real Property: Dunng the 12 months be/ore May 11 of the year the deduction is to be eHect�ve..p� ��
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yea%the dedudti��o 6e effective.
See reverse side !or additional instrucfions and qualifications. �` �/1 n n
buyer-
i axing
restrictionsyn reverse
Key number I
Rewrd number
03-755 /
- Page number
-oo a 9�-�
Assesse v lue of real property as of MoRgage / Contract indebtedness unpaid as of Is the applicant the sole legai or equitable
March 1, rrent year March 1, current year owner? ['�'�es ❑ No
vd
If no, what 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 the , perty in question:
eal Property ❑ Mobile Fiome QC 61.1-�
�e of mortgagee or contract seiler � %/ . � v 9_ 2� �//
�_', v !" � c/ T
�Q
Address of mortgagee or contract seller (number and et, city, state, ZIP —_ _
Name of assignee or other owner or holder of mortgage
NO... �� - 7SS� 1.
Address of assignee (numberand street, city, state, ZIP code) •ard N�. ,
.................... (
Does applicant own property in any olher If yes, what county? Whal Taxing DislricC! ,�- �� - i requested on
county in Indiana? property for wrrent year?�] Yes� No
I P�- N� �- P 1�( �/D" ��� COUNTY AUDITOR ��
i Deduction approved in the amount of:
20
Signature
20 � I 20 UL I 20
�
County Auditor
20 ��
/
20 �
T
Date
20
I/ We certify under the penalty of peryury that the above and foregoing information is true and correct and that the applicants was ! were
�sident of Indiana and owner of the aforementioned property on March 1, 20
of
Person aulhorized by duly executed Power of Aitomey
or by IC 6-1.1-12-.07
oi authorized person