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/� �n � STATEMENT OF MORTGAGE OR CONTRACT INDE6TEDNESS
°i: , r FOR DEDUCTION FROM�ASSESSED VALUATION Count Township Year
«. ,' SUteFwm43709 (R6/5-06) � ��4, � A,.•'�;- � �
� Presoibed by Depanment of Lopl Gwemrtrent Finance ��
wsrRUCrioNS: �EP � 2 Zp07 File Maric
To be filed in person or by mail with the County Audito� of the county where the p�operty is loca ed.
Filing Dates: 7) Real Property: Dunng the 12 months 6efoie ,lune I7 of the year lhe deduction i e ef/�
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0/�� the d�uctio is to be e(fective.
See �everse side fo� additional instructions and qualifications. ' �,�gSON COUNTY A11D�7��
(owner or crontracf buyer
� nvN) i i � 9�- � �
°e iestrictions o�rgG�rse side)
.Ce�n `�-Q� a�
Key number / legal description Record
�
J a�-�i-�3ao��cr�a.SlSy-� Paenumber � ���
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year ownef? ,�es ❑ No "
�
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
moAgagee or contrad seller — �
Address of mortgagee or contraIX seller (number and street, city,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
� i ;
in the amount of:
20 �� 20
P
We certify under the
esident of Indiana ai
m
ZIP
Property ❑ Mobile Home (IC 61.1-�
_ Dra«�er 1\*Q,�Q . `C 70
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1Nha �3 �OO....' .. ........... uestedon
� G('%Q GL ] YesO No
COUNTY AUDITOR
�
County Audilor
20
20
20
if perjury that the above and foregoing infortnation is We and corred and that ihe applicants was / were
of the aforemenlioned property on March t, 20
Person authorized by duly executed Power of Aftomey
or by IC 6-1.1-12-.07
�sident address of applicant Address of authorized person
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