HomeMy WebLinkAboutMortgage_Holzmeyer (5)i i rt��"� STATEMENT OF MORTGAGE OR CONTRACT INDESTEDNESS
`\i,•�, FOR DEDUCTION FROM ASSESSED VALUATION Count Tovmship vear
\�J ( State Farm 43)09 (R6 / 546) - � � ' ' �
� Presaibed by DepaAment of Local Gwemment Finance
INSTRUCTIONS:
DEC 2F�e�a�
To be filed in person oi by mail with the County Auditor o/ the county where the property is located.
Filing Dates: 1) Real Property. Du�ng the 12 months 6elore June Il of the yea� the deduction is to be e/fei�Q%t7t1N��
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2�of the �gs(!�q � ����p�Rective.
See �everse side fo� additional instrsictions and qualifications.
or
Assessed value of real
March 1, current year
buyer-
of
what is his / her exact share of
If name on
� s o verse side)
;ey r/legalde
�
�� — 67�'�b•5%3�0'� rage numsev ,Q J? � u
V �
Mortgage / Contred indebtedness unpaid as of Is the applicant Ihe sole legal or equitable
March 1, current year ' owner? � � Yes � No ' '
� O�
If owned wifh someone other than spouse, indicate with whom.
ihan ihat of applicanf, indicate below:
contred seiler
Address of mortgagee or contraIX seller (numbe nd st2et, aty,
Name af 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 county?
county in Indiana?
couNrr
Deduction approved in the amount of:
20 '� I 20 � I 20 20
s the property in queslion:
❑ Real Property ❑ Mobile Horrie QC Cr1.1-
� ��� -f"r I l./
,ted on
:s � No
Au�rTO�'s oFF�
a�o� - �3s �
� 5� / ���"`�`-��"
�
Signature County Auditor
`_'�'1 wI � Le -
� s ��� �
We ceAify under the penalty of perjury that the above and foregoii � ,{, �„ % / were
/•v�" 1iL
., resident of Indiana and owner of the aforementioned property on P.._ _.__,.__ __ __ ��
Signature (owners (ull name) Person aulhorized by duty executed Power of Attomey
� or by IC 6-1.1-12-.07
='u^ll resitlent address of applicant Address of authorized person
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