HomeMy WebLinkAboutMortgage_Priar (3)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
's ,«. / Sute Fwm 43709 (RS / a-03) . . . . � " " . � . . . . .
� PresaiEM by Departmeni of Loral Govemmenl Finance
INSTRUCTIONS: �g File Ma �� � �)
To be filed in person or by mail with the County Auditor of the county w6ere the property is located.. . A �� 1� �
Filing Dafes: 1) Real PropeRy: DunngYhe 12months before May 11 of the year the deduction is to be eBective.
2) Mobile Homes assessed under IC 6=7.1-7: Between January 15 and March 2 0/ the year the deo''�u�t%n is'j�o S�(�(ective.
See reverse side for additional instructions and qualifications. � , � _
Applicant
Taxing Distrid
Assess�l value of real property as of
March 1Vcurcentyear
Ii no, what is his / her exacl
Key number % le�al 8es�ption _ Record number � �/
��� � � �v _ �\ Page number �
o w
Mortgage ! Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, currenf year ownerl ❑ Yes ❑ No
__� gmc�0
Ii owned with someone other ihan spouse, indicate with whom.
If name on record is different than ihat of applicant, indicate below:
�ame of mortgagee or contracl seller
. 0.
Address of mortgagee or contract seller (number and street, city, state.
Name of assignee or other owner or holder of mortgage
assignee (num6er and st�eet; city, state, ZIP code)
Does applicant own property in any other I I; yes, �shat county� I\Nhat Taxing District?
county in Indiana? i
Deduction approved in the amount of:
20 20 �
�
Signalure
2G �'�
l.
COUNTY AUDITOR
20 d L 20 j{�_
{
/ /
County Auditor
property in question:
❑ Real Pruperty ❑ Mobile Home (IC 61.1
Has this dedudion been requested on
property for current yea(?� Yes❑ No
20
Date
20
/ We certify under the penalty of perjury lhat the above and foregoing information is true and corred and thal the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signafure
d address of applicant .
,llaX /�?-� �O,vl,s�ao�.tN �f�6�9
Person authorized by duly executed Power of Attorney
or by IC 6-t.t-12-.07
of authorized person