HomeMy WebLinkAboutMortgage_PatelSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
- • FOR DEDUCTION FROM ASSESSED VALUATION
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Prescribed Dy DeDartment ol Local Govemment Finance
INSTRUCTIONS:
To be filed in person or 6y mai! with the County Auditor of the counry where the property is located.
Frling Dates: 1) Real Property: Dunng the 12 months 6e%re May 11 0l the year the deduction is to be eNectiye) j 1 i 2��3
2) Mo6ile Homes essessed under IC 6-1.1-7: 8etween January 15 and March 31 0( the year fhe deducfion is to 6e eHective.
See reverse side for additional insVuctions and quali�cafions.
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A ticant(owne�orcontracfbuyer-see
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Taxing Distrid
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Assessed value of real property as of
March i, wrcent year
I( no, what is his / her exact share of inlerest?
� on reverse side)
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number / legal description
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Record numb
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Page number
Mortgage / ContraC indebledness unpaid as of Is ihe applicant tF�e sole legal or e
March 1, current year owne(t ��Yes ❑ No
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If owned with someone other lhan spouse, indicale with whom.
name on record is different than that of applicant, indicate below:
of moAgagee or conlract seller
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Address of mortgagee or contract selier (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand sfreet, city, state, ZIP code)
Is the property in quesUOn:
❑ Real PropertY ❑ Mobile Home (IC Gt.t-�
Does applicant own property in any other If yes, what county? Whal Taxing Distrid7 Has this dedudion been requestea on
county in Indiana7 property for current year? 0 Yes❑ Nc
20
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Signature
COUNTY AUDITOR
approved in the amouni of:
20 v S 20 LJ Cc 20
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County Auditor
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1/ We certify under lhe penalty of perjury.that the above and foregoing information is true and correcl and that the applicants was / were
a residenl of Indiana and owner of lhe aforementioned property on March 1, 20
Person authorized by duly executetl Nower ot Attomey
or by IC 6-1.1-12-.07 �
Address of authorized person
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