HomeMy WebLinkAboutMortgage_Simpson (5)r 4 STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Count 7ownship Year
�� . / SUte Fortn 43709 (R6 / 5-06) • • . � p � �
�� Presaibed by Department of Lonl Govemment Finance N
g
INSTRUCTIONS .IAN pi�����i!3
To be fi/ed in pe�son o� by mail with the County Auditor of the county whe�e the property is located. .�
Filing Dates: 1) Rea/ P�operty: Dunng the 12 months before June.11 of the year the deduction is to be eflecti�. ,G��,
2) Mobile Homes assessed under lC 6-1.1-7: Between January ]5 and March 2 of the ye���F�eQded�NTY ��DITORctive.
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See �everse side for additional instructions and qua/ifications.
Appli owner or contract buyer- see restnctions on reverse side)
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Taxing District Key number / legal description Record number -� O D Q
. �
Z�C�u,c.,c� � - a � - �8 _ i 3 = ,200 � = '
Page number
Do� .�o! - D a s 0 0 a--
Assessed value of reai property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes � No �
S I�� ,
If no, what is his / her exact share of interest? If owned with someone other than spouse� indicate with whom.
If name on record is difierent than that of appiicant, indicate below: Is the �rooertv in auestion
of moAgagee
'" �,Q�1'Y w ZY�v
Addreas of mortgagee or wntrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (number and street, city,
Does applicant own property in any other If yes, what counry?
county in Indiana?
20
approved in the amount of:
�
� I P
Signature
❑ Mobile Home (IC 51.1-�
_= - �-�a�a.?-.�z
pia���er �O"' ' ' ,- '
What Tax . t • • " � �sted on
IC,�ar�� � ����;�19a.00 �es❑No
V" "'
COUNTY AUDITOR
20 20 20
County Auditor
20
Date
20
certify under the penalty of perjury thal lhe above and foregoing information is true and corred and lhat the applicants was / were
lent of Indiana and owner of ihe aforementioned property on March 1, 20
of
Z�
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person