HomeMy WebLinkAboutMortgage_Chamberlain (6)i;� STATEMENT OFMORTGAGE OR CONTRACTINDtBTEDNESS
t\ FOR DEDUCTION FROM ASSESSED VALUATION Count Townshi Year
`� • Slate Farm 43709 (R6 / S06) � . , � �
� Presoibed by Depanment of Lonl Gwemment Finance
OCT.1 1 2007
INSTRUCTIONS: Fde Mark
To be filed in person or by mail with the County Audito� ot the county whe�e fhe property is localed. `�j
Filing Dates: 1) Real Property: During the 12 months before June 17 of the year the deduction is to be eflective� �`� ��'
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 oI the year�g���pp�tp Atl��ve.
See �everse side for additional inst�uclions and qualifrcations.
Applicant (owner or contract
Taxing Distrid
see
OC l0 —
Assessed value of real property as of
March 1, current year
what is his / her exad share of interest?
If name on
on r�erse side)
0
/ legal description I Record number Q�
_/
3b_ � y\p� _�yy(�'� C� ^�l Page number
'((JlJ litJ�/ J
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
O Ul/C/ ..
If owned with someone other than spouse, indicate with whom.
than that of applicant, indicate below:
mortgagee or contrad seller
Address ot mprlgagee or contrad seller (number and stieet, lt�y,,state, ZIP _
Name of assignee w
Address
owner ar holder of mortgage
and st�eet, city, "
Does applicant own property in any other I If ye,
counry in Indiana?
Deduction
20 �
Signature
in the amount of:
20 �� 20
�
�'/.S`- l9
��i4 �
.�' l��,i(/i7�1 �U'�Cf.Fir✓
00 _
�d� C�C�nC/i T AUDITOR
�
County Auditor
20
❑ Real PropeAy ❑ Mobile Horrie (IC Cr1.1-�
Has this dedudion been requesled on
property for current year?� YesO No
�
20
We certify under the penalry of perjury lhat the above and foregoing infortnation is true and corred and that the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
�n � ne (ull name)/�/J / Person authorized by duly executed Power of Attomey
n /1��,. /�!/A�r�.60 sQ7� �..__ or by IC 6-1.1-12-.07
/� Nooress or auinonzea person
S �\/� 1/�/�2 .� L/ i L/i. t