HomeMy WebLinkAboutMortgage_Beard (3)� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
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PrescriCed by Depanment of Local Govemment Finance i� N^ 1�
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INSTRUCTIONS: APR 1F�ileAM1�i�
To 6e filed in person or by mail wifh the County Auditor of the county where the property is located. /
Filing Dates: 1) Real Property: Dunng the f 2 months be)ore May 110! the year the deduction is to 6e e/fective. !� ��
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deductron'Js�to be,�fifective.
See reverse side for additional instrucfions and quali�cations. r �,� `�v'` ��� 17 �� v��� J� �
Applicant (owner or contract buy - see restnctions on verse side
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Taxing District Key number / legal description Record number
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O/ _��[ �� � r/R Page numbe�
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, curtent year March t, curtenl year owne(? ❑ Yes ❑ No
�540 �
Ii no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
�ame of mortgagee or contract seller
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Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder ot mortgage
Address of assignee (number and sfieet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for current yeaf? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 �_ 20 � 20 �1 20 �_ 20 �_ 20 20
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Signature County Audilor Date
�'/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
i resident of Indiana and owner of the afore entioned property on March 1, 20
Signatur owners name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Fu I reside address of applicant Address of authorized person
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