HomeMy WebLinkAboutMortgage_Adamsi�� y STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
1\. = FOR DEDUCTION FROM ASSESSED VALUATION C un sh Year
_`: , � .y� State Fwm 43709 (R6 / 5-06) �
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Presoibed by Depariment of Loral Gwemment Finance
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INSTRUCTIONS: �� ��Mark
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1J Real P�operty: Dunng the 12 months before June 11 0( the year the deduction �+16SI�I��tATCfY AUDITOR
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0l the yea� the deduction is to be effective.
See reverse srde for adddional instructlons and qual�cations.
Applicant
District
td"� /g C�'! -�
Assessed value of real property as of
March 1, current year
If no, what is his / her exact share of interest?
on record is different than that of
of mortgagee or conVact seller
on �everse side)
Ke�mber / legal description Record number �
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' Page number
Gl� /U - �
MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year owneR ❑ Yes ❑ No
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I/ owned with someone other than spouse, indicate with whom.
betow:
Address of mortgagee or contrad seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numbe� and st�eer city, state, Z/P code)
Does applic - - ' ' - -"— -' �'--- --�-• --•-•�� N/hat Taxing Distrid?
county in Ir
Dra�ti�er NO. �l1.�0 ...�.,�r,g
�UNTY AUDITOR
Deduction; CpBCCI i�'�. ...�...//... n /J
�/ %i%�� �-%� Ct.ao 1..�+.-1�
20 0 8 �� O, /OC1. o 0 0
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Signature
County Auditor
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Is the property in questian:
❑ Real Property ❑ Mobile Home pC 61.1-�
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Has this deduction been requested on
property for curtent year? � Yes� No
20
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certify under the penalry of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
lent ot Indiana and owner of the aforementioned property on March 1, 20
�ce (owners lull name) Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
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�id-e t� address of appliqnt Address of authorized person
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