HomeMy WebLinkAboutMortgage_Glaser (2)N" STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
" ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�, M: J S�ate Fam 437W (R4 / 10-01)
� Prescribe0 by Department of Loal Govemment Finance
INSTRUCTIONS: �9—i � � k�t.F.ile Mark '
To be filed in person or by mail with the County Auditor o/ the county where the property is locaied. ��/
Filing Dates: 1) Real Property: Dunng the 12 months belo2 May 11 0l the year the deduction is to be ef/ecfive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of the��r tHe de�n is to 6e eflective.
See reverse stle tor atltll6onal inshuc6ons antl quali�ca6ons. ��,J��
Applicant (owner or t buyer- see 2st '' s reverse side) ""��'�� ��UtiTY AUDITOR �
Taxing Dislrid Key number / legal description Record number ��
O //-00 �] �� � Page number �
/
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the appliqnt the sole legal or equitable
March 1, current year March 1�enl year owner? ❑ Yes ❑ No
�5� ���
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 applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Hmie (IC 61.1-�
�,me of mortgagee or conirad seller A
,..�'�/1 / /
13�.. v`
Address of mortgagee or contract seller (number and st2et, aty, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and s6eet, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distric[? Has this dedudion been requested on
county in Indiana? property for curtent yea(? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 .Q� 20 20 g� 20� 20 �� 20 �_ 20 �
� � � ��
Signature County Auditor Dale
;
' We certify under lhe penalty of perjury that the above and foregoing infortnation is true and corred and lhal ihe applicants was / were
. resident of Indiana and owner of the aforementioned property on March 1, 20
gnature (owner's full n� Person authorized by duly executed Power of Attomey
or by IC G1.1-12-.07
F II r ident address of applipni Address of authorized person
SO�'o? GtJ. � ; n,e �5�.