HomeMy WebLinkAboutMortgage_Wethington (2)STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Towns1hi Year
S�p � J SI2te Fortn 43709 (R4 I 10-01 j � � l7 �7
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� Prescribed by Depattment af Local Govemmeni Finance — 1�J
JUN 3 � Y003
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Audi[or of the county where the property is located.
Filing Dates: 1) Real PropeRy: During the 12 montbs be%�e May 11 of the year fhe deduction is�o,be e/fecf'rve. � .
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2) Mobile Homes assessed under IC 6-1.1J: Behveen January 15 and March 31 o th�e.�yea �Uieadeduction�isRo�be eHective.
See reverse side (or additional inst�uctions and qualifications.
Appiicant (owner or co tract buyer - see rest�ns o_n rqverse i)
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Taxing District Key number / legal descri i n Record number ��
,�'�/�/_ _ �a � g��� Page number � �
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Assessed value of real prope as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitabie
March 1, current year March 1, currenl year ownef? ❑ Yes ❑ No
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If no, what is his / her exact share of interesl? If owned with someone other lhan spouse, indicate with whom.
If name on record is diiferent than that oi appticanf, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Hane QC 61.1-�
�me of mortgagee or conVact seller ��
Address of mortgagee ar contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sheet, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for cunent yeaf? � Yes❑ No
COUNTY AUDITOR
Dedudion approved in the amouni of:
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Signature County Auditor Dafe
�/ We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that lhe applirants was / were
resid t of Indiana and owner of the aforementioned property on March 1, 20
(o ners (ull n�ne) Person authorized by duly executed Power of Attorney
�� or by IC 6-1.1-12-.07
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u re ident address of applicant Address of authorized person