HomeMy WebLinkAboutMortgage_Williams (7)j�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
s'�' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�yJ State Fortn 43709 (R6 / SO6)
� Presaibed by Department of Loml Gwemment Finance
INSTRUCTIONS: ���
To be �led in person or by mail with the County Auditor of the county where the propeRy is loca �j'�
Filing Dates: 1) Real Property: DuAng the 12 months 6e/oie ,lune 17 of fhe year lhe deducGon i�e elfecUve.
2) Mobile Homes assessed under IC 6-1. 7-7: Between January 15 and March 2 of the yeas ti�a d�dtJc��Ys to be effective.
SP.a �eveise side (nr addiiinnal inclnic�inne anll nnal�ralinnc �Hlv
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Applicant(owneroraontractb yer- restrictionson_rgvers side) � I ' 0 UN
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Taxing Distrid Key number / legal description Record number ^�/
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as o Is the applicant the sole legal or equilable
March 1, currenl year March 1, currenl year owneR � Yes ❑ No
115�
If no, what is his / her exact share of interest? If owned wifh someone other than spouse, indicate wilh whom.
C� bb- 57
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobiie Home QC 61.1-n
e of mortgagee or contrad seller /� \���
l�n� � 1
Address of mortgagee or contract seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of moRgage
Address of assignee (number-�^'� �
Does applipn " (7.lJlf. J� •••"' �� � What Taxing Distnd? Has this dedudion been requested on
county in India pl•a�VCt" �0" ��� bo property for wrrent yeaR�] Yes❑ No
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Card �0��'�.
f '�^� """ �OUNTY AUDITOR
t�I�'l
Dedudion appro� _ �l, a�nounl of:
20 Q� 20 20 20 20 20 20
P P
Signature Counry Auditor Date
We certify under the penalry of perjury that the above and foregoing information is lrue and corred and thal the applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
S'�qnature (owne/s lull name) Person authorized by duly executed Power of Attomey
��'� S y or by IC 6-1.1-12-.07
F II J dent address of applicanl Address of authorized person
7 INe 'f �/aCaw�" 51 �arf �rc.�,l /l ''(lE`t�
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