HomeMy WebLinkAboutMortgage_Brown (3)`O N" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i 4-" ' FOR DEDUCTION FROM ASSESSED VALUATION
� � / State Form 4J709 (R4 / 70.01) � � .
� Prescribed by Depanment ot Local Govemment Finance
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INSTRUCTIONS:
To be fi/ed in person or by mai! with the County Auditor ol the county where the property is located.
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Filing Dafes: 1) Real Property: During the 12 months belore May 11 0l the year the deduction is to be eNective.t Q 2003
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ /the year the deducfion is to be ef/ective.
See reverse side lor additional instructions and qualifications. I/ ` �� �
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.,pp�iwm �owner or conrracr ouye�- see resmcnons on reverse sltle)
I`�o v,t�j o m e r
Assessed value of real property
March 1, cunent year
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Key number / legal description
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of MoRgage / ContraG ir
March 1, current year
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If no, what is his / her exact share of interest?
name on record is differeni than that of applicant,
below:
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Record number
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Page number
unpaid as of
Is the applicant th ole legal or equital
owneR Yes ❑ No
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If owned with someone other than spouse, indicate with whom.
'am�f moAgagee or confract seiler
� J-n tea �-�t l3 a v� � N, A,
Address of moRg e or contract seller (number and street, city, state, ZIP
21 5. c, 3�. , E,r�r � s v� lle �..�%b
Name of assignee or other owner r holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any olher If yes, what counry?
counry in Indiana?
ueaucnon approvetl m the amount ot:
2004 � 20
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Signature
Is the pr
❑ Real
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r ❑ Mobite Home QC 61.1
What Taxing Distnct? Has this tledudion been requested or
property for current yeaR � Yes ❑ N
COUNTY AUDITOR
20 d � � 20
County Auditor
20 � I 20 �_
Date
20
/ We certify under the penally of perjury that the above and foregoing in(ormation is true and correct and that the applicants was / were
i resideni of Indfana and owner of the aforemenlioned property on March 1, 20
Signatu (owners full name)
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Full resident address oi applicant
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Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
[�7� -7O IAddress of authorized person