HomeMy WebLinkAboutMortgage_LumsdonSTATEMENT OF MORTGAGE OR CONTRACT INDI
s FOR DEDUCTION FROM ASSESSED VALUATION
\ � Sfate Fam 43709 (R3 / 10-00)
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� PmstribeC M SUte BoarC of Ta�c Commissionets
Instruetionsforfiling:
To be filed in person or by mail with the County AudRor of tlie county where the property is
located during the 12 months before May 11 of the year the dedudion is to be effedive. See
reverse side for additional instrudions and qualfip6ons.
FORM 5
AUG 2 ' 2001
C'�CJ:.�Ty P.UD! �OR
Applipnt (ownerorconhact buyer- see 2strictions on reverse side)
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Taxing DisViG Key number / legal descrip6on Record number
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Page number
00 - -a a �l c��8
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applipnt the sole egal or equitable
March t, current year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is d'rfferent than that of applicant, indicate below: �^l �� 1
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�e of mortgagee or conVad seller �� � � i
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Address of mortgagee or contrad seller nu ber aj�d s6eet, city, state, ZIP
,Qs..sz_ � 0�1—\��``
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sUeet, dty, state, ZIP code)
Does applipnt own real property in any If yes, what county? What Taxing Distrid? Has this dedudion been requested on
other county in Indiana? property for wrzent yeaR ❑ Yes ❑ No
COUNTY AUDITOR
DeducGon approved in the amount of:
zob� � Zo zo 20 � zo o� zo zo a r' �
�s p ,� P
Si nature County Auditor Date
J We ceRify under the penalty of perjury that lhe above and foregoing infortnation is irue and corred and that the applicants was / were
ident of Indiana and owner of the aforementioned propeRy on March 1, 20
Signature owners ame) Person authorized by duly executed Power of Attomey
2 or by IC 6-1.1-12-.07
F resident address of applicant �ry^e`�h s�N Address of author¢ed person
�2ks� Box �ss< J�!/a��. �F7G�o
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