HomeMy WebLinkAboutMortgage_WintersSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION o ,.Township Year
ti+ «. / State Fwm 43709 (R5 / 4-03) . . , apt"-- i . .
� PrespiDetl by DepaRment of Lotal Guvemment Finance �J ��
� 20�6
INSTRUCTIONS: File Mark
To be filed in person or by mail with lhe County Auditor of the county where the property is located.
Frling Dates: 1 J Real Property: Dunng the 12 months 6elore May.l f o/ the year the deduction is to be�c�c��
2) Mobile Homes assessed under IC 6-1.1J: Between January 15 and March 2 0l ���kl @�bgBGCUonis'(o 6e effective.
See reverse side for additional instrucfions and quali�cations.
� ���.�
Assessed value of real property as of
March 1, current,year
If no, what is nis / her exact share of interest?
an 2verse side)
Key number / legal description
D/�- 00��0=�'.
Mortgage / Contract indebtedness
March 1, currenlyear
Y
as
Record number
��o �'
Page number
.. . �� �
f Is the applicant the sole legal or
ownef? ❑ Yes ❑ No
owned with someone other than spouse, indicate with whom.
If name on record is differenl than that of applicant, indicate below:
'me of moAgagee or contrect seiler /j �
��.l�1C�1L
Address of mortgagee or contract seller (number and s t, city, state, ZIP
Name of
Does
count
Deduct
20 _Q_�
Signature
or olher owner or holder oi mortgage
�f assignee (numberand stree!_ �;w_��-•_ �•o �e)
J'r,u+� a'�"' ,. . .. . ..
�I'a��'el' ��.......
CaCd ��. .....Yw�.........
`� �i% 'J��.�
� � ;
ounty? I VJhat Taxing District?
COUNTY AUDITOR
20 �j_ 20 20
�V O
County Auditor
�. (V40�
s the property in
❑ Real Pm�erty ❑ Mobile Hmie (IC 67.
Has this dedudion been requested on
property for current yeaR � Yes� No
20
Date
20
certify under the penalty of perjury that ihe above and foregoing information is true and wrred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-72-.07
of a�licant � � � �Address of aulhorized person