HomeMy WebLinkAboutMortgage_Fidler� i�`��� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i' FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
w. ♦ Stale Farm 43708 (R8 / S-06)
� ResaibeE by Dapenmerit o1 Loral Gwemment Finance
INSTRUCTIONS: q9- Y File Mark
To be filed in person or by mai! w8h fhe County Auditor of the county where the p peRy is loca d� ti0�1
Filing Dates: 1) Rea/ Prope r t y.• Dunng the 12 mon t hs before ,lune Jl o/ the yea� the dedu 1�}�is�o be elf tive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Marc�2 o/the y�'ded��(ion is to be effective.
\�
See reverse side for additional instrt�ctions and quali�cations. '�%1 �oUN�y P�
ApplicaM (owner a
Taxing
Assessed velti9 pifea!
March 1, auren! year
If no, what is his / her ezact
-see
as of
ofinterest7
on
Key number / legal description
Record number O
V� ` 3- 6sb -oa Page number � �
MoRgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, curtent year owneR ❑ Yes � No
�$ v�
If owned with someone other lhan spouse, indicate with whom.
If name on record b dAereM than that of applicant, indicate below:
�me of moAgeQeo or cantrad seller
..
Address of mottgegee or corrtract seller (number and st .t, city, state, ZIP
Name of eesignee or dher owner or holder of mortgage
eaaipnee (number and str
Does app!'ic�q am properly in any otl
county in Indiena9
Deduction approved in the amount of:
20 � I 20 �
P
Signature _
� s • /If
L,
:o � �� �
^��������"
��� _.. �K
20 20 20
County Auditar
❑ Real Property p Mobile Home QC 61.1-�
t? Has this deduction been requested on
property for curtent yeaR � Yes 0 No
20
20
We ceAify urMer ihe penalfy of perjury that the above and foregoing information is true and corred and that the applicants was / were
asident of �iana and owner o(th�fofjementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person