HomeMy WebLinkAboutMortgage_Byrns/de "n � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�i'�; FOR DEDUCTION FROM ASSESSED VALUATION
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'v _ w� �! SUte Form 437C5 (R6 / 5-06)
� Presaibed by Depanment of Local Govemment Finance
INSTRUCTIONS:
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File Mark
To be filed in person or by mail with the CountyAuditor of the counfy where the p�opeRy is located. � U N 0� Z��%
Filing Dates: 1) Real Property: Dunng the 12 months before ,lune �t of the year the deduction is to be effective.
2J Mobile Homes assessed under IC 6-7. 7-7: Between January 15 and March 2 0( the ye�r� �e d� ction is to 6e efiective.
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See reverse side lor additional instnictions and quali(ications. �� (/
�I�SON COUNiY AUDITOR
Applicant (ownerorcontract buyer- see,r�,striytfons on reve� side)
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Tauing District Key nu ber / legal descripti Rewrd number
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d�_�-7-oti-4oa-000.���-oa� l �,.� � Pagenumber
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Assessed value of real propeAy as of MoAgage / Conlrad indebtedness unpaid as of Is the applican the sole legal or equitable
March 1, current year March 1, curtent year ownef? es ❑ No
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If no, what is his / her exad share of interesl? If owned with someone other than spouse, indicale with whom.
If name on record is different lhan lhat of applicant, indicate below: Is the property in question:
Propetly ❑ Mobile Home (IC 61.1-n
�me of moAgagee or contrad sell� _
Address of mortgagee or contrad seller (numbe and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand st�eet, city, state, ZIP code)
Dces applipnt own property in any other If yes, what county? What Tazing Distrid? Has this dedudion been requested on
county in Indiana? property for curtent yeaR� Yes� No
/ s T�� a� COUNTY AUDITORa
D uction approved in the amount of:
20� 20 d� 20 G7( 20 20 20 20
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Signature County Auditor Date
�/ We certify urider the penalty of perjury thal the above and foregoing information is true and correG and thal lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signatu e ow r full name) Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
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Full reside t addr applip Address of authorized person
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