HomeMy WebLinkAboutMortgage_Cluttere��' � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Is: = FOR DEDUCTION FROM ASSESSED VALUATION
� J State Farm 63709 (Ft6 / 506)
7 �� Presaibed by DepaNnent of Loral Govemment Finance
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INSTRUCTIONS:
C Township Year
MAR �, 6 2007
ile Mark
To be filed in person o� by mail with the County Auditor o/ the county where the p�operty is located. `�y� �
Filing Dates: 1) Real Property: Durfng the 12 months before ,lune 11 of the year fhe deduction is to be effecdGe`.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the y�g��@,��i��g�ective.
See reverse side lo� additional insfnutlons and qual�caUons.
Applicant (o e� or contract uyer - see re 'ctions on reverse side)
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Taxing ''ct Key number / gal description Record number .D n
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n/�/_�/)/On� Pagenumber ���
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Assessed value of real prop as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year Maroh 1, current year owner? � Yes � No.
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If no, what is his / her exact 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:
❑ Real Properry O Mobile Home QC G1.1-7)
,�: of mortgagee or contract seller - — - — — — --
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Address of mortgagee or conVact seller (number and s6eet, city, state, ZIP
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Name of assignee or other owner or holder oT mortgage Card \r� . .....................
Address of assignee (number and st2et, crty, slale, LP code)
Does appiicant own property in any other Ii yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property tor current year? QYesO No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � 20 Q� 20 � 20 20 20 20
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Signature County Auditor Date
��e certiTy under the penalty of perjury ihat the above and foregoing infortnation is true and correct and that the applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owne/s full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07 . '
Full resident address of applicant Address of authorized person '' ��