HomeMy WebLinkAboutMortgage_Keil (5)�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-' = FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S y s�a�e Form aa�os �aa i iaoi�
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Prescdbed by Department of Local Govemment Finance
INSTRUCTIONS: � �� ;;'� �ark
To be filed in person or by mail with the County Auditor o/ the county wheie the property i lo at �-'�
Filing Dates: 1 J Real Property: During the 12 months before May 11 0l the year the deduc on is ecCrve�
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and Maich 31 o( (h� yU �th����(uction is to 6e eHective.
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See ieverse side (or additional instmctions and oualifrr.atinns .
Applicant ( wne ntract 6uyer- see re n'ons o rever e de) �' GIB ��p� ��p�;i, v t UDITOR
Tauing District �/���' Key numbe egal description Record number �
_ OO� /� � _ O� Page number
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Assesse alue of real property as of Mortgage / Contrad indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1 current year Marc��rrent year owne(? ❑ Yes ❑ No
\F� d �Q �
If no, what is his / her exact share of interest? � If owned with someone olher than spouse, indicate with whom.
If name on record is diHerent ihan that of applicanl, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Hane (IC 61.1-�
�me of mortgagee or contract seller
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Address of mortgagee or conVad seller (number and t2et, city, state, ZIP
Name of assignee or other owner or holder of moAgage
Address of assignee (num6er and st�eet, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for current yeaR� Yes❑ No
COUNTY AUDITOR
Dedudion approved in the amount of:
20 _Q,Z 20 20 20 20 20 20 �
� �P P P �
Signature County AudRor Date
� We certify under the penalty of perjury that lhe above and toregoing information is true and corred and thal the applicanis was / were
a residenl of Indiana and owner of the aforementioned property on March t, 20
Signature (owners full name) .. Person aulhorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
full resident address o applipnt Address of authorized person
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