HomeMy WebLinkAboutMortgage_Greenwell (2)��
STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCT�ON FROM ASSESSED VALUATION Coun 7ownship Year
�• ! State Fwm 43709 (RS / 4-03)
�«.
� P2saibed by Deparimeni of local Govemment Finance
INSTRUCTIONS: File Mark
To be /iled in person or 6y mail with the County Auditor of the county where the property is located. ,-` ��� " �;� --�
Filing Dafes: 1J Real Property: Dunng the 12 months 6efore May 11 of the year the deduction is to be eBective:'"� �� ;� f�--� � �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to•tie.effectiv�
See reverse side for additional instnictions and qualifications. st r�'� 2004
/� i/
ApplicaM (owneror cont buyer- see restnctions reverse side) J,� ,.� �� yj //
/ �,�,. ,�F��.�s_(�r�
GICSOY :0'Rf Y AUD:7C� �
Taxin Distrid Key number / legal description Record number �
QO � ^ Q�' /_ 'Q � �Qf1 Page number / �O �
(/ t� � �� `1
Assessed value of real property of Mortgage / Contrect indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrtent year March 1, current year ownef? ❑ Yes ❑ No
� S �36�
If no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate wilh whom.
If name on record is different than ihat of applicant, indicate below: Is the property in question:
❑ Real Pmperty ❑ Mobile Home (IC 61.1-�
�me of mortgagee or conlrad seller � ^
1J
Address of mortgagee or wntract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP crode)
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for current year? C] Yes ❑ No
COUNTY AUDITOR
Deduction approved in fhe amount of:
20 �_ 20 20 � 20 20 20 20
P � �
Signature County.Auditor Date
� We certify under the penalty of peryury lhat the above and foregoing intormation is true and corred and lhat ihe applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
' nature (own s full name Person authorized by duly executed Power oi Attorney
or by IC 6-1.1-12-.07
ul resid t dd s licant Address of authorized person �
3 �