HomeMy WebLinkAboutMortgage_Epperson (2)�'° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
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Presaibe0 by DepaNrent W Laal Govemment Finance
INSTRUCTIONS: �� 1ile 1yr
To be filed in person or by mail with the County Auditor of the county where the property is lo�. �� �.��
Filing Dates: 1) Real Property: During the 12 months before May 11 of the year the deduction to b r�e.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 the year the c�dQ� is fo be effective.
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aee reverse s�ae ror aoamona� msnucnons ano quauncanons. �--
Applicant (owneror t t buyer- see resMcti s on erse side) G1g50� ��NT� pUD1 •'
Taxing Dislrict � Key numb / I gal description Record number
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U(JO �%�� CJ
Assessed value of real property as of MoRgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, currenl year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diiferent than that of applicant, indicate below: Is the property in question:
❑ Real Pmperty ❑ Mobile Home QC G1.1-�
�ine of moAgagee or conVact seller ,n �
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Address af mortgagee or conVad seller (number and st2et, aty, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st2et, city, state, ZIP code)
Dces applicant own property in any other If yes, what counry? What Taxing Distrid? Has this deduclion been requested on
county in Indiana? property for current yea(? 0 Yes ❑ No
COUNTY AUDITOR
Deduction approved in fhe amounl of:
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Signature County Auditor Date
/ We ceAiTy u r the penalty of perjury lhat the above and foregoing infortnation is true and corred and that lhe applicants was / were
a residen ndiana and owner of the aforementioned property on March 1, 20
gn re !u� e� Person authorized by duty executed Power of Attomey
or by IC E1.1-12-.07
Fu r" nt addr s of applipnt Address of authorized person
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