HomeMy WebLinkAboutMortgage_Cornoyer� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S �" � SUte Fam a3709 (R4 / 70.07)
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� Presqibe0 by Departmenl W Local Govxmment Finance
INSTRUCTIONS: � � � F�a�
To be filed in person or by mail with the County Auditor of the county whe�e the property is locat �L
Filing Dates: 1) Real PropeRy: Dunng the 12 months be%�e May 11 of the year the deduction is to be eflective.
2) Mobile Homes assessed under IC 61.1-7: Behveen January 15 and March 31 0/ the yea}�/IU c�duc('rorS�r'� to be ef/ective.
See 2verse srtle roraUU�honal msWCUOns antl qualitica6ons. /
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Applicant (o e or contract b yer- s res s on reverse ' e) ' �� �����' Y�U�ITOR :
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Taxing Distrid Key number / legal descriptio Record number �
_Q ��� � ^^` Page number �
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Assessed value of real property s of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year ownef? ❑ 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 diHerent than that of applicant, indicate below: Is the property in question:
❑ Real Pmperly ❑ Mobile Hane (IC G1.1-�
�-ne of mortgagee or contrad seller . �
Address of moAgagee or contract seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applicanl own property in any other If yes, what counry? VJhat Taxing District? Has this deduclion been requested on
county in Indiana? property for current year? � Yes ❑ No
COUNTY AUDITOR
Dedudion approved in the amouni of:
20 ,�� 20 20(ZS 20 20 � 20 _� 20
� � P � P
Signature County Auditor Date
�� We certify under the penalty of perjury that the above and foregoing infortnation is true and corzed and that the applicanls was / were
��i3�nt of Indiana and owner aforementioned property on March 1, 20
Sign (o nefs 1 na e) � Person aulhorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
F I s den address of applip Address of authorized person
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