HomeMy WebLinkAboutMortgage_Garwoode`"rt�°'t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
a>4 " : FOR DEDUCTION FROM ASSESSED VALUATION Count Township Yeai
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I� � P�escnOM Ey Department of Local Government Pinance
INSTRUCTIONS: N���e�t�� 2004
To be filed in person or by mail with the County Audiror o/!he county where the property is located.
Filing Dates: 7) Real Property: Dunng the 12 months be%re May 11 0l the year the deduction is fo 6e e tive.
2) Mobile Homes assessed under IC 6-1.1J: Behveen January 15 and Ma�ch 31 0( the y r t6e de ucC n i 6e e ctiv .
See reverse side !or additional inst�uclions and quali�cations. ��630N C U Y AUDiTOR
Applicant (owner or contracf buyer- see restn/ctions on reverse stle)
n �� e _ ) _ _ .. I /' _ _ . _ . , � n w .l� � �'. ,n �.. �
Taxing Distrid
' �a t� �� Tw�P � _
Assessed value of real property as of
March 1, current year
If no, what is his I her exact share of inierest?
Key number / legal description
�
DO 6 �l 25�,�' 1-DD
Mortgage / Contract indebtedness unpaid as
March 1, current year
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If name on record is different than that of applicant, indicate below:
��ame of mortgagee or coniract seller
lh�'�G � �a ln
Address o( m�tgagee or contrad sel
2��, 'Th r �--�
Name of assignee or other ow eri r or I
Record number O �
�
Page number
,;<
Is the applicant ihe �ole legal or equital
owner? [�es ❑ No
If owned with someone other than spouse, indicate witn wnom.
and street, city, state, ZIP
of mortgage
Address of assignee (number and street, city, state, ZIP code)
Goes applicant own property in any other If yes, what coun�
county in Indiana? � �
approved in the amount
20 �_
1
Signature _
20
s the property m
❑ Real Property ❑ MoGte Home QC 61.1
,
Taxing Disirict? Has this deduction been requested or
property for curreM yeaR� Yes� N
COUNTY AUDITOR
20 �%� 20 20
� �
Counry Auditor
20
Date
20
� I/ We certify under the penalty of perjury�that the above and foregoing information is true and correct and that the applicants was I were
a resident of indiana and owner of the aforementioned property on Nlarch t, 20
� SignaWre (avners (ull na ) / Person auihorized by duly executed Power of Atbmey
� c� . ^ r' !. . - - - , / or by IC 6-1.1-12-.07
\ n . � e s�--c /il _ _
l
0
of authorized person