HomeMy WebLinkAboutMortgage_Clark (6)�e�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'' = FOR DEDUCTION FROM ASSESSED VALUATION
�v�, _ J Sute Fartn 43709 (R6 / 5-06)
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Presaibed by DepaNnent ot Local Govemment Finarxe
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INSTRUCTIONS: File MaAc 5 Z��$
To be frled in pe�son o� by mail wdh the County Auditor o( fhe county where the property is located. MAR �)
Filing Dates: 1) Real Property: During the 12 months befoie ,lune 17 of fhe year lhe deduction is to be elfective.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of lhe year the deducGo��e.
See reverse side /or additional instnictions and quali(rcations. G�BS�N COUNTY AUDITOR
(owner or contrapt��yer � see
Taxing
v d�o-�
Assessed value of real property as of
March 1, current year
If no, what is his / her exad share of
side�
Key number / legal description
,� b'��
Mortgage / Contrad ii
March 1, wrrent year
W J i�
If name on record is different ihan thaf of applicant, indicate below:
as
Record number �C.�
b
Page number (�r�
Is the applicant the sole legal or equitable
owneR � Yes ❑ No
If owned with someone other than spouse, indicate with whom.
��e of mortgagee or contrad seller ^� �
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Address of mortgagee or conVact seller (number and street, city, state, ZIP
Name ot assignee or other owner or holder of mortgage
s the property in question:
❑ Real PmpeAy ❑ Mobile Home QC 61.1-�
(num6erand street, crty, sfate p�
Drawer \'O.�GQA.:... ��
Does applipnt own property in any olher If yes, wl > this dedudion been requested on
county in Indiana? C�1"(1 � O. �• oerty for curtent yeaf? O Yes❑ No
�i���-�.Qk �Gsaz�. o 0
Deduction approved in the amount of:
20 _ L Y 1 2o O`1 I 20
� I P
Signature
COUNTY AUDITOR
20
County Auditor
20
20
Date
20
certify under the penalty of perjury lhat the above and foregoing information is true and corred and ihat the applicants was / were
I�nt of Indiana and owner of the aforementioned property on March 1, 20
Iull
1
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person