HomeMy WebLinkAboutMortgage_Doane (2)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-- � FOR DEDUCTION FROM ASSESSED VALUATION
t � Spte Form 437Q9 (R3 / 10-00)
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� PresaibeC N' Sfate Boartl of Tax Commissioners
Instructions for fiiing:
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 12 morrths before May 11 of the year the dedudion is to be effed'rve. See
reverse side for addifional insWctions and qualfications.
�N,o,� ,
Assessed value ofreal
March 1, current year
no, what is his / her exad
buyer- see �e tnctions on reve e side)
, C ?�u � � �1�.-� q�
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Key number / legal descriptio
D��' O��C�� �
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.rty as of � Mortgage / Contract indebtedness unpaid as
March 1, curcent year f{j � � � ��
FORM 5
Coun Township Year
� � � � �
JUL�02001
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: „�,,,�, � � i /
Is the applicant the sole legal or
owneR ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indiwte below:
� of mortgagee or conVad seller
�•
Address of mortgagee or contrad selier (number and sheet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
and street, dty, state, ZIP code)
Does applipnt own real property in any I Ii yes, what county?
other county in Indiana?
Fd�]
approved in the amount
_ T�
20 �_ I 20
What Taxing DisUid?
COUNTY AUDITOR
20 /i.7
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County Auditor
20
Has this deduction been requested on
praperty for wrrent yeaR 0 Yes� No
20 0 I 20 �Z
P P
Date
certify under the penalty of peryury that the above and foregoing information is We and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
ir �full n ) Person authorized by duly executed Power of Attomey
� � or by IC 6-1.1-12-.07
>ident address of applicant � Address of author¢ed person