HomeMy WebLinkAboutMortgage_Williams (10)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
,. / State Fwm 43709 (RS / d-03) � �
Piescribed Oy Department of Local Govemment Finance �
s � �.
.r ��
i� INSTRUCTIONS: � File Mark
To be filed in person or by mail with the CountyAuditor o/the co�nty where the property is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 01 the year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: 8etween January 15 and March 2 of the year the deduction is to be e/fective.
See reverse side /or additional instructions and qualifications.
Assessed value of real
March 1, curcent year
If no, what is his / her exact
- see
side)
Key number / legal
of I Mortgage / Contrect ir
March 7, c ent year
�Il9D
a�-►q-lQ-aO�-DOi. 3a��-oa c�
If name on record is different than that of applicant, indicate below:
e of mortgagee or contract seller /�/�/j
Address of mortgagee or contract seller (number and street,
or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry?
county in Indiana?
Deduction approved in the amount of:
20 � 20 �_ 20
Signature
If
state, ZIP
number
Page
unpaid as of I Is the a
owner?
�a9a
t the sole legal or equitable
❑ Yes ❑ No
with someone other than spouse, indicate with whom.
Whal Taxing District?
COUNTY AUDITOR
20 � 20
V
County Auditor
��c�
❑ Real
❑ Mobile Home (IC E1.1-7)
Has this deduction been requested on
property for current year? ❑ Yes ❑ No
20
20
We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
'esident of Indiana and owner of the atorementioned property on March 1, 20
(owners
Person
1-12-.07
person