HomeMy WebLinkAboutMortgage_Cummins (3)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S / Sute Fwm 43709 (RS / 4-03) �
�'«• PresaiDed by Department of Local GovemmeM Finarke ce ,,,, 1'r � .(?J �N
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wsrRUCnoNS: aF�!e ^�� 2004
To 6e filed in person or by mail with the County Auditor of the county where the propeRy is located.
Filing Dates: 1J Real Property: During the 12 months 6efore May 11 of the year the deduction is to be eflecl e. Q
2) Mobile Homes assessed under IC 6-1.1 J: Between January 15 and March 2 0/ the year the deductiom s to�be eff ��
See �everse side for additional instructions and qualifications. :.-�urv �: i;un i v A! �, TC' �
Applicant (owner
reverse side)
�g Distrid " � Key number / legal description Record number
�fn/'S� n�,, „ L �//_ oD ��r /� Page number
i.,;_, ,wi�[�/� Y
Assessed value of real properfy as of MoAgage / Contrad indebtedness unpaid as of Is the applicani the sole lega or EI
March 1,.wrrent year March 1, current year owneR ❑ Yes ❑ No
�
If no, what is his / her exad share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different than thal of applicant, indicate below: Is the property in question:
of moRgagee or contracl seller
Address ot mortgagee or contrad seller (number and
Name of assignee or other owner or holder of mortgage
Address of assignee (number and stieet, city, state, ZIP code)
Does applicant own property in any olher � If.yes, what county?
county in Indiana? �
Sig
e� No • �O`� .
�raw 1Dy � •
�t0 000.a'�
Card �y0,
❑ Real Properry ❑ Mobile Hane (IC 61.1-�
state, ZIP
What Taxing Distrid? Has this dedudion been requested on
property for currenl year? �] Yes 0 No
COUNTY AUDITOR
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County Auditor
Date
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We certify under lhe penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
esident of Indiana and owner of the aforemenlioned property on March 1, 20
full
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person