HomeMy WebLinkAboutMortgage_Miller (4)��' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�'��� FOR DEDUCTION FROM ASSESSED VALUATION . Co nt Township Year
: .�+ State Fwm 43709 (R6 / 5-06) � �
� Presaibetl by Department ol Lotal Gwemment Finance
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�NSrRUCrioNS: ��� F;� ��p�
To be tiled in pe�son o� by mail with the County Audito� of the county where lhe p�opeRy is located. •
Filing Dates: 7) Real Property: Dunng the 12 months be(ore �une I1 of the year the deduction is to be effecti� ,Q
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the yeg�����N���e effective.
See reverse side for additional instniclions and qualifrcations. AUDITOR
orCOntract buyer - see restric6o2s on reverse side)
Tauing Distrid
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Assessed value of real property as of
0.larch 1, curtenf year
Key number / legal description I Record number
�� � g-oZ �-at v� -00 D, j/ q_ Page number
26 �
MoAgage / Contrad indebtedness unpaid as_of Is the applicant the sole legal or equitable
March 1, airrenl year � owneR ❑ Yes � No `
9Sao�
If no, what is his / her exact share of interest? Ii owned with someone other tlian spouse, indicate with whom.
If name on record is different than that of applicani, indicate below: is the property in question:
. ❑ Reai Properfy ❑ Modle Home Q(
�e of mortgagee or contrad seiler
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Address of mortgagee ar conVact seller (number and street, city, state, IP � -
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxir U 1':l �YC 1" � �. �� S..�. /. �� � on
county in Indiana? � I I No
. `.
Cal"d NO. ..........�......... 4
COUNTY AUDITOR�h�� ��� ��s I
Deduc6on approved in the amounl of:
�1��.'��m
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Signature
%Z�]
County Auditor
20
�
Date
20
We certify under lhe penalty of perjury that the above and foregoing information is true and correc[ and that the applicants was / were
esident of Indiana and owner of the aforementioned properfy on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of applicaqt „, ,^ , �Address of authonzed person