HomeMy WebLinkAboutMortgage_Adams (5)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�+ �w� ! Sia[e Fwm 63709 (RS / 4�3)
� P2scribed by Oepartment of Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months be%re May 11 07 fhe year the deduciion is to
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ tAe
See 2verse side for additional instructions and qual�cations. �
6uyer-see
Taxing
Assessed Galue oi real property as of
March t, current year
'nc6on n reverse side) ^
v /�
Key nu er / legal description
� ��
Mortgage / Contrad indebtedni
March 1, current year
If no, what is his / her exact share of interest?
on record is different than that of
indicate below:
File Mark
be edective. � -�--�
y �arlhe�du�t�n is� e�tive.
1L
JAN p6 2004
1� � I Page number
�
unpaid as of Is the applicant the sole legal or equitable
ownef? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
'ime of mortgagee or contract seller � I� �
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or olher owner or holder of mortgage
assignee (num6er and st2et, city, state, ZIP
Does applicant own property in any other If yes, what counry?
county in indiana?
Deduction approved in the amounf of:
20
Signature
2oD(c
( � �` _v..'�
What Taxing District?
COUNTY AUDITOR
20 �� 20 �� 20 �_
� � �
County Auditor
Is lhe property in queslion:
❑ Real Property ❑ Mobile Home (IC 61.1-�
Has this deduction been requested on
property for current yea(?� Yes❑ No
20
Dale
�
We certity under the penalty of peryury lhat the above and foregoing information is true and corted and ihat the applicants was / were
esident of Indiana and owner of the mentioned property on March 1, 20
nQture�ful/ na� Person authorized by duly execuled Power oi Attomey
� � _ or by IC 6-1.1-12-.07
of authorized person