HomeMy WebLinkAboutMortgage_Meeks\� rt�� —.^i i ATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�+ �_ � I State Fortr. d3709 (RS / 4-03)
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Prescnbed by Department ot local Govemment Finance
lNSTRUCTIONS: File Maric
To be fi/ed in person or by mail with the County Auditor of [he county where the property is located. ��G 2`i 2��5
Filing Dates: 1) Real Property: During the 12 months befo2 May 11 07 the year the deduction is to b e ective.
.� 2J Mobile.Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0! the year the dedy,ction is to be eNective.
See reverse side for additional instructions and quali�cations.
`�j6�., F� r+�,
- r_iaSON COUNTY AUDITOR
Applicant (owner or fra er- e c' ns on r verse side)
Taxing Distrid Key number / legal description Record number �
`�`�� iV �.(�t/' � �D /�o l g� (�Q� Page number
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of is the applicant the sole legal or equitable
March 1, wrtent year ,: March 1, currenl year ownef� ❑ Yes ❑ No
V
If no, what is his / her exact share of interesl? If owned wifh someone other than spouse, indicate with whom.
If name on record is different than Ihat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Modle Home QC 61.1-n
�3me of mortgagee or contrad seller /�
/ J 00 - 9S
Address of mortgagee or contrad seller (number an street, city, state, ZIP
Name of assignee or other owner or holder oi mortgage
Address of assignee (number and street, 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
Deduction approved in the amount of:
20 � 20 � 20 O 20 20 20 20
� � P
SignaWre County Auditor Date
�/ We cenify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
i ture (ow s ull n Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full r e d e of applican Address of authorized person
/SO S: .�Ky��vt iaR; vt