HomeMy WebLinkAboutMortgage_Shamsaie`" rt� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i--._ '� FOR DEDUCTION FROM ASSESSED VALUATION ' Count Township Yeai
� S�a:eFwm437W(R4170-Ot) - � -" -
,�. I�� � �I !?-�' :
PrescriDeO Dy Department ol Local Govemmenl Finance
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INSTRUCTIONS: �AR 1���M�u�4
To be filed in person or by mail with fhe County Audifor of the county whert the propeRy is located. �
Filing Dates: 1) Real Property: Dunng fhe 12 months 6elore May 11 of the year fhe deduction is to�be'elfective. ��
2) Mobile Homes assessed under IC E1.1-7: Between January 15 and March 31 of the�yeor the:dedu�fi`'is tMo b�� tive
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See reverse side Ior additional instructions and qualificafions.
contract buyer - see restrictions on reverse side)
Taxing Di trict Key number / legal description
' P.a�-o ka- Tw � ' _
C706—OZI�� cJC�
Assessed value of real property as of MoRgage / ContraG indebtedness unpaic
March 1, current year � March 1, curtent year
If no, what is
name on record
her exact share
than that
Name of mortgagee or contract selle
�n-1-e G ru l3a h �
Address of m gagee or conlrad se
2� s�' �
Name of assignee or othe owner or
Address of assignee (numberand
Record number
� 03 _
Page number
as of I Is the al
ownef?
1, �th�e sole legal or equita
ry� Yes ❑ No
j' 7Y. 75 D. 0 � � �
�— If owned with someone other than spouse, indicate with whom.
applicant, indicaie below: Is the pr
D Real
�_ i� ,�Q Q 1`c`w�
(number and street, city, state, ZIP --�
v�,� i (I T � 77b,�
ier of mortgage
�
!, city, state, ZIP code)
❑ Mobile Home QC 61.
Does applicant own property in any other If yes, what counry? What Taxing District? Has this deduction been requested o
counry in Indiana? property for curtent year?� Yes❑ 1
Deduction
20
the amount of:
20 �
COUNTY AUDITOR
20 0� 20 OY 20 � 9 20
� P
County Auditor Da1
20
�I/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
a resident of Indiana and owner of lhe aforementioned property on March t, 20
�
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5/.�.yy> r �..2
of applicant
n n . . .-�
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Person authorized by duly executetl t'ower ot nnorney
or by IC 6-1.1-12-.07 �
Address of authorized person