HomeMy WebLinkAboutMortgage_Slickerfe��" ,� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'' � FOR DEDUCTION FROM ASSESSED VALUATION
�_«..! StareFortn43709(R6/5-061 �
Presrnbed by Department of Lo<al Govemmem Finance
INSTRUCTIONS:
Coun Townshi Year
FI
NOV OF3 M006
To be filed in person or by mail with the CountyAudrtor of the county where the property is located. �
Filing Dates: 1) Real Property: During the 12 months 6efoie ,lune I7 0/ fhe year the deduction is to be efle �
2) Mobile Homes assessed unde� IC 6-7.7-7: Between January 15 and March 2 o(the ye��hONd� '� i �ffective.
See reverse side for additional instructions and quali(catrons.
Applicant (o or contrdct bu r- s 2stri ' n on reverse side)
Taxing Distrid Key number / legal escription Record number /
///�� / /.�— % /��a-0�—�/�•� �/—GL2 % �(O
/ C.�7FJ�Q �(J � . �- 6�J I /I- �D Page number � �% �
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, current year March 1, current year owneR ❑ Yes ❑ No
/� � �do
If no, what is his / her exad share of interest? If owned with someone olher than spouse, indicate with whom.
If name on record is difierent than that of applicanl, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Hmie pC 6�1.1-�
me of mortgagee or contred seller ',/�
/
7�"
Address of mortgagee or contract seller (number and street, city, state, ZIP .
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, sfate, ZIP code)
�hat county? What Taxing District? Has this deduclion been requested on
�' property for curcent yean � Yes ❑ No
S�iGC�� O�N=�`6
COUNTY AUDITOR
� � 0�-���i
2� � 20 �� 2� � Za 2� 2� 20
P
Signature County AudRor Date
We certify under the penalty of perjury that the above and foregoing informalion is true and corced and thal the applicants was / were
resident of Indiana and owner of ihe aforementioned property on March 1, 20
� Sign ture (owners lull name) � Person authorized by duly executed Power of Attomey
^ or by IC 6-1.1-12-.07
� esi ent address of applicant Address of authorized person
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