HomeMy WebLinkAboutMortgage_Douglas (7)i i�' � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
1i' = FOR DEDUCTION FROM ASSESSED VALUATION Township Year
\. .,«. / State Fwm 43709 (R6 / 5-06) � � � ' �
� Presaibed by Department of �ocal Gwemmenl Finance
INSTRUCTIONS:
U�` FileAta���
To be filed in person or by mail with the County Auditor of the county where the property is located. � ,/� �
Filing Dates: 7) Real Property: Dunng the 12 months before June Il o! the yea� the deduction is to be ef(edive.�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the yE88ff@���'���ffective.
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See reverse side /or additional instrucfions and qualifrcations.
see
Key number /
number • ^ y
�U �
�J (1 b' � C_�J -Z%� fl�i: 7� 7 P3g� number �! 1Q �
O�. d�C� � 1 !
Assessed value of real praperty as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year ' March 1, current year owneR ❑ Yes ❑ No '
� 19D
If 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 mortgagee or contrad
indicate below:
af mortgagee or contred seller (number and street, city, state, ZIP
assignee or other owner or holder oi mortgage
Address of assignee (number and street, city, state, ZIP code)
Does app��am own oroperty in arry other If yes, what county? What Taxing Distric[?
county in - — - _
�� /�� l
n/j.r �C� � OUNTY AUDITOR
Deductic �''fi" 1 '/i
�w�� S
20 �
i
Signature
���������.OU
�
?0 I 20
County Auditor
Real Property ❑ Mobile Home (IC 61.1-�
e
Has this dedudion been requested on
property for cunent yeaf? � Yes ❑ No
20
20
ceM1ify under the penalty of perjury thai the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforemenlioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
person