HomeMy WebLinkAboutMortgage_Michel`°R�'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-' : FOR DEDUCTION FROM ASSESSED VALUATION Cou' owns'ip ' ar
5 � J SUte Portn a37os (R4 / t 0-0t )
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� PreSttibeE by Department ot Local Govemment Finante
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INSTRUCTIONS: File ark/
To be lled in person or 6y mail with the County Auditor ol the county where the propeRy is located. •� D
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Filing Dates: 1) Real PropeRy: Dunng the 12 months belore May 11 0l the year the deduction is fo be e ectiu�ON COU�7� AUDITOR�
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and March 31 of the year the deduction is to be ef/ective.
See reverse side (or additional rnstructions and qualifrcations.
Applicant (o or ntract buyer- see restrictions on iever e side)
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Taxing District Key number / legal de ' ti ecord nurtjt}�r — ��
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Page number
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March i, curtent year March 1, current year ownef? ❑ Yes ❑ No
��od a
If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
- -14- 4 - � .306 -�a�
If name on record is different ihan lhat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�'
�ame of moRgagee or contrad �ayer
�r
Address of mortgagee or contrad seller (number an s reet, city, state, ZI
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Districl? Has this deduction been requested on
county in indiana? property for wrrent year?�1 Yes❑ No
OUNTY AUDITOR
Deduction approved in the amount of:
20 � 2� 20 2� � 2� P 2� � 20 �nG
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Signature County Auditor Date
I/. We certify under the penalty of perjury lhat the above and foregoing infortnation is true and corred and ihat the applicants was / were
J� resident of Indiana and owner of the aforementioned property on Marcli 1, 20
i fure (owner's full n me) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
u esident address of applicant Address of authorized person