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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
b ✓ Sute Fwm 43709 (RS l 6-03) ' _.
�«•
� P25criDed by Department of Lotal Govemment Finance
INSTRUCTIONS: �� File � �
To 6e filed in person or by mail with the County Auditor of the county whe�e the property is located.
Filing Dates: 1) Real Property: During the 12 months belore May 11 of the year the deduction is to be e/fec �ve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the ct'on is to 6e effective.
See reverse side tor additional instructions and quali(cations. ��� � 0 2��6
(owner or contract
Taxing Disiriq
��/
Assessed vatue of real pi
March i, current year
no, what is his / her exaa
see restrictions or 2vers side)
%'� � �
Key number / legal de
as of
ofinterest?
If name on record is diHerent ihan lhat of
mortgagee or contrad seller
AUDITOR
Record
� ^ � �O SS- Page number � � �� �
MoAgage / Contracl indebtedness unpaid as of Is the applicant the sole legal or equitabl
March 7, current year owneR ❑ Yes ❑ No
&� ����m.�
Ii owned with someone other than spouse, indicate with whom.
indicate below:
�I �
Address of mortgagee or contrect seller (number and street, city, state, ZIP
�ab Name of assignee or other owner or holder of mortgage
�� ^� Address of assignee (number and sfreet, city, state. ZIP code)
�s,e Does applicant own property in any other If yes, what county?
county in Indiana?
Dy"
�Fp
Deduction approved in the amouni of:
zo f ➢^I zo 08
P
Signature
What Taxing District?
COUNTY AUDITOR
20 Q� 20 20
e
Couniy Auditor
s lhe property in question:
❑ Real Properry ❑ Mobile Home (IC Fr1.1-
Has this dedudion been requested on
property for current year?� Yes� No
zo
Date
zo
certify under the penalty of peryury that the above and foregoing information is true and correc[ and thal lhe applicants was / were
lent of Indiana and owner of the aforementioned propeAy on March 1, 20
(owners (ull
address of
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
authorized person