HomeMy WebLinkAboutMortgage_Martin (7)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� w� ! State Pwm 43709 (R5/4-03) . , ' �
� Presaibed by Department of Local Gdvemment Finance
INSTRUCTIONS: kj--, Fiple.Ma�k.�
To be filed in person or by mail with the County Auditor of the county where the property is located� ,y� � (Cj�� � l�
Filing Dates: 1) Real Property: During the 12 months be%re May 11 0/ the year the deduction is to e eBective,J �/ ��
2) Mobile Homes-assessed under IC 6-7.1-7: Between January�l5 and March 2 0/ the year the deduction is to be ef(ective.
See reverse side for additional instructions and qualifications. APR 3 � 2004
� / � �� n
Applicant ( e� or contract buyer- see resMc ' ns on er e side) �tJy��—<--��1i�.j/
' Gi°SON GiiUFl7 � Al•Ui7r"'
Taxing Disl d Key number / legal description Record number
�1 �/j / � I 1 � �lil �9 �b— � Page number ��S
tJ � � � l fJu � �
Assessed vatue of real property as of Mortgage / ContraIX indebtedness unpaid as of Is the applicant the sole lega or equitable
March 1, current year � March 1, current yee.r owneR �❑ Yes ❑ No
8lV�/�/
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 different than ihat of applicant, indicate below: Is the property in question:
❑ Real Properry ❑ Mobile Home (IC 61.1-�
�ame of mortgagee or conirad seller '
Address of moAgagee or contraci seller (number and street, city, state. ZIP
Name of assignee or other owner or holder oi mortgage
Address of assignee (number and street, city. state, ZIP code)
Does applicant own property in any other I If yes, �ti1:at counry? t�V;,at Taxing DistriIX? Has this deduction been requested on
county in Indiana? property for current year?� Yes� No
I
COUNTY AUDITOR
Deduction approved in the amount of:
20 _Q,� 20 O!� 20 � 2C"�� 20 � 20 20
d� P ���
Signature County Auditor Date
�/ We certify under the penalty of perjury that the above and (oregoiny infortnation is true and corred and ihat the applicants was / were
resident of �ndiana and owner of the aforementioned property on March t, 20
- ature (ownels full name) Person auihorized by duly executed Power of Atlomey
—��/y� 1--- or by IC 6-1.1-12-.07
�!t�zr.j
II res� ent a dress o appiicant Address of authorized person
� _p/Y: N%n,'/�-- —