HomeMy WebLinkAboutMortgage_Houdyshell� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
's �,«. / Siate Fortn a37W (RS / 4-03) _ _ , _ . -" ; \
� PresrnUM �y Department ot Laal Gtivemment Finance ' , '� ';— �'—i / �; ,'
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INSTRUCTIONS: �i�e Maik� ZQQ4
To be filed in person or by mail with the County Auditor o/ the county where the property is located.
Filing Dafes: 1) Real Property: Dunng the 12 months 6efore May 11 of the year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be effeUi �.c�
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See reverse side for addifional instructions and qualifrcations. '�i�SC'' =r�� ��� �' ^�!'':�C�
Applicant (ownerorcontract 6uy strictions on reverse �
Taxiry'�I, District 1 ey number / legal description Reco number
j� /��� JA/I I n , � _ /�f �i_ D Page number �
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Assessed value of real property as o Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March i, wrrent year March 1, curr�y� 1�� ���j , p0 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 different than lhat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�-ne of mortgagee or contract seller �
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Address of mortgagee or contrecl seller (number an st2et, cit te, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicanl own property in any other If yes, what county? What Taxing Districf? Has this dedudion been requested on
county in �ndiana? property for current year? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in lhe amount of:
20 (C�_ 20 � 20 �� 20 20 20 20
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Signature County Auditor Date
�'' We certify under the penalty of perjury thal the above and foregoing information is true and correcl and that the applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
' nat e(own rs full na e) Person authorized by duly executed Power oT Attomey
or by IC 6-1.1-12-.07
Full re ident dres f pplicant Address of authorized person
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