HomeMy WebLinkAboutMortgage_Pollock� rt�ry
e t
a'�'- -
: �
«.
�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fortn 437 W(R4 ! 10.07)
PrescnGeO by Depanment of Local Govemment Finance
INSTRUCTIONS:
To 6e filed in person or by mail with the County Audilor of the county whe�e the property is located.
Filing Dates: 1) Real Property: During the 12 months befo2 May 11 oJ the year the deduction is to be effer�i�q.y 1 5 2�02
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ the year the deduclio is t�etive.
See reverse side /or additional instructions and qualificafions.
iJ __., ; „�.. _' •
�- .__... ___..
Applicant (owne� or cont ct buyer - see restri tions on rever side�Q-4/-� W� '
Taxing Distrid Key�ber egal description Record number
O
� Page number
Assessed vatue of real property as f MoRgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owne(? ❑ Yes ❑ No
If no, what is his / her exact share of interest? I( owned with someone olher than spouse, indicate with whom.
If name on record is different lhan ihat of applicanl, indicate below: Is the property in question:
❑ Real Property p Mobile Home QC 61.1-n
��ne of mortgagee or contrad seller
�� ('� A r„ n �J il
Address of mortgagee or wntract seller (number and street, city, afe, ZIP — �1� �
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for current year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
O�
Zo �_� zo zo 20 � zo � zo � zo o p' �
� s �-r� eo � � P P ,a �
Signature County Auditor Date
� We certify under the penalty of peryury that the above and foregoing information is true and correct and ihat the applicanls was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
Si ture (o ners /ull name) Person authorized by duly execuled Power of Attorney
�` ,(�„ � ���J or by IC 6-1.1-12-.07
I resident address of applicant �..�„��E-rON Address of authorized person
� '`�a2 $�X,�78F� i.�/ -.