HomeMy WebLinkAboutMortgage_Dewigia�y � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
-y State Fwm 43703 (R6 / 5-06) .
��� Prestribed by Department of Local Gwemment Finance
To beR e�TION Sson or by mai/ with the CounlyAuditor of the county where fhe property is l�� ��jFil Ma
Filing Dates: 1) Real Property: DuAng the 12 months before ,lune 11 0/ the year the deduction is fo be elfective.
2) Mobile Homes assessed under IC 6-1.1 J: Between January 15 and March 2 ot th�'�r tfje de�ducg'on is to be effective.
See reverse side for additional instructions and qual�cations.
Applicant
Taxing Distrid
see
Assessed value of real property as of
March 1, current year
If no, what is his / her exact snare
reverse side)
Key number / legal ption
a�-�9-lq-ao -ooi.3s�
MoRgage! Contract indebtedness unpaid as
March 1, currenl year
�rd n�i mber ?1F�/
�number C � 2 �i �
c�u o
Is the applipnt the sole legal or equitable
owneR ❑ Yes ❑ No
3� oo�o I
owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below:
�e of mortgagee or cantrad seller �� � ^
{'
I
Address of mortgagee or conUac! seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee.(number and sheef, city, state, ZIP code)
— - -- �
Dcesappli� U��H15'CI' 1�7�„p�jQ� 7_�3 ���r? WhatTaxing District?
county in h �
C:ll'(� l�i� . . ...............�J F
��3�I �1OQ.QO /%N� �%OUNTYAUDITOR
. ,�, t�F
Deduction approved in the amount of: '
20
Signature
20 �,`L
20 20 20
County Auditor
❑ Real Property ❑ Mobile Horne QC G1.1-�
propertyforcunent
20
20
iestetl on
Yes � No
certify under lhe penalty of perjury thal the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners /ull name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07 .
ot 2�icanl v �Address of authorized person