HomeMy WebLinkAboutMortgage_Reneer`'-�� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION T i Year
_ ' ✓ Sta;e Fwm 6370g (RS / 4-03) ,
�� Prescribed by Department ot local Govemmenl Finance .'
AUG 0 2 2005
INSTRUCTIONS: File Mark
To be filed in person o� by maii with the County Auditor o/ the county where the propeRy is located. `-�
Filing Dates: 1) Real Property: Dunng the 12 montbs 6e%re May 11 0/ the year the deduction is to be effe�ve.a� 'a�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the y@�g��.p�qEjqryiy�(y{��f(ective.
See reverse side lor additional instructions and qualifications.
(owne� or confract buyer- see restrictions on reverse side)
Taxing Distrid
( a�ti � � S� �
Assessed value of real property as of
March 1, cunent year
e r r , � ���
Key number / legal description
If no, what is his / her exact share of interest?
��� �
Mortgage / Contract i�
March 1, current year
name on record is differeni than that of applicant,
of mortgagee or coniract seller
below:
Record number
Page number
>� �vy
unpaid as of Is the applicant t e sole legal or
owne(? ❑ No .
owned with someone other than spouse, indicate with whom. �
o( mortgagee or contrad seller (number and st2et, cily, state, ZIP �
Name oi assignee or other owner or holder of mortgage
of assignee (numberand s6eet, city, state, ZIP
Does applicant own property in any other If yes, what county? I VJhat Taxing
county in Indiana? �
Deduction approved in the amount of:
20 �� 20 ��
P �
Signature
COUNTY AUDITOR
20 20 20
P
County Auditor
Is the property
O Mobile
Drawer Np, �� �` 7-��
Card NO . .....................
20
Date
20
Fr1.
i on
� No
' We certify under the penalty of perjury that ihe above and foregoing information is true and corred and thal the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20 .
�n � e( vners (u!/I �name �] Person authorized by duly executed Power of Attomey . .
1 . �..// � _ _ // or by IC 6-1.1-12-.07 ..
of authorized person
��_ � /