HomeMy WebLinkAboutMortgage_ShoemakerSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
- FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
\ � S�ate Fam 43709 (R4 / 1P47)
u.
� Prescri0e0 by DeDartment of Local Govemment Finarxe ���� �
INSTRUCTIONS: JAN �ileA�3
To be filed in person or by mail with the County Auditor of the county where the property is located. LUU
Filing Dates: 1) Real Property: During the 12 months belore May 11 of the year the deduction is to be ef/ective.
2) Mobile Homes assessed under IC 6-1.1J: Behveen January 15 and March 31 0/ th ar the dedi��tio�r��,is to be_ ?eff�ctive.
7C���. _(,4_cJ�
See reverse side lor addrfional ins6uctions and qualifica6ons. GIBSON �O�!N? Y�U�)I70R .
Applicant (owne r ontract buyer - see strictlons on reverse side) .
Taxi isVid Key nu er / legal description Record number O�
Q Q ) � _ �' �/ �� /� ` Page number O �
-J lJ(J
Asse ed value of real property as of Mortgage / CantraC indebtedness unpai e appliqnt the sole legal or equitable
March 1, curtent year March 1�rrent year 9i owne . ❑ Yes ❑ No
� . W� ��� , �Op
If no, what is his / her exact share of interest? If owned wi e other than spouse, indicate with whom.
If name on record is dif(erent than ihat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home pC G1.1-�
�3me of mortgagee or contract seller ��I
Address of mortgagee or conVact seller (number and sheet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand st2et, city, sfate, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has lhis dedudion been requested on
wunry in Indiana? property for current year? 0 Yes � No
COUNTY AUDITOR
Dedudion approved in the amounl of:
20 � 3 20 20 20 � 20 �Z 20 � 20
P �° � /�
Signature County Auditor Date
�/ W rtify under the penalty of perjury that the above and foregoing infortnation is lrue and coned and that lhe applicants was / were
�, re ident of Indiana and owner of the aforementioned property on March 1, 20
i ature (owners /ull name) Person authorized by duly exearted Power of Attomey
_D - or by IC 6-1.1-12-.07
OS
F dent address of appli t Address of authorized person