HomeMy WebLinkAboutMortgage_Moore (2)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S ' j Sfa[e Fqm 43709 (R4 / 10-01)
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Presai�etl by DeDartmenl of Local Govemment Finance �
INSTRUCTIONS: File Mark
To 6e filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months belo2 May 11 oJ the year the deduction is to be eHecNv�. �- �� �—��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Maich 31 0/ the year�t6e�de�c � n is �eNective.
See �everse side for additional rnstructions and qualifica6ons. �--�
DEC 2002
Applicant (owner cont ct u er- see restn n on rev rs side)
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mg \ strict Key number / legal description Record ntimber•,o��` C7'J`�TY AUDITOR �
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Assessed value of real prope as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March , current year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? — If owned ith someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Moble Home QC 61.1-�
�me of mortgagee or conVact seller �
3
Address of mortgagee or conVad seller (number and stieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st�eet, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
counfy in Indiana? property for current year? 0 Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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drY GTA�of4 � f' P
Signature County Audftor Date
/ We certify under the penalty of perjury thal lhe above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signa (owners /ull name) Person authorized by duly executed Power of Attomey
` / or by IC 6-1.1-12-.07
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; Full resident addr s pli nt Address of authorized person
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