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� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
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' P�esaibed by Depertment of Local Govemment Finance �� �(� �
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INSTRUCTIONS: N O V Q� Z�,{le Mark
To be filed in person or by mail with the County Auditor of [he county where the property is located. �»
Filing Dates: i) Real Pioperty: During the 12 months be7ore May 11 oI the year the deduction,is to be eliectives� ^
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year lFie d'eduction Is to �e e8ective.
See 2verse side for addi6onal inshuctions and qualiTcations. ��"`"��`�(���h�
�Ip�t7n ou� r 7 nNetT�jj
or con,tr-a�c/t
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Taxing District
%�CL�,CQ �LQ
Assessed value of real property
March 1, cunent year
no, what is his / her exact share
on
Key number / legal
� - ois�99- �
Record number O �
Page number Q,p�
of Morlgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owner? ❑ Yes ❑ No
/�� , O��
�f interest? If owned with someone other than spouse, indicate with whom.
name on record is difterent than that of applicant, indicate below:
�e of moAgagee or conlract seller ��
'ddress of mortgagee or wntract seller (nu er and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, ciry, state, ZIP code
Does applicanl own property in any other If yes, what county?
county in Indiana?
%b7
Signature
amount
20�
�
Is the property in
❑ Real Property ❑ Mobile Home (IC E1.
Drawer N�DI -;.g � �.`�.
Card Np' ..
. , . ._ . .
COUNTY AUDITOR
20 0 �e 20 U
1
County Auditor
ction been requested on
„�.,Nerty tor curcent year? 0 Yes ❑ No
20 � � 20 �_ � 20
� P
Date
certify under the penalty of perjury that the above and foregoing intortnation is true and cortect and that the applicants was I were
lent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC E7.1-12-.07
resident address of applicant C� �Address of authorized person