HomeMy WebLinkAboutMortgage_Colbert�'� 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION Coun T Year
� «. / Stete Fwm 43709 (R6 / SO6)
� Presaibed by DepaNneni of Lotal Gwemment Finance
MAY 1 6 2007
INSTRUCTIONS: File Mark
To be �led in person or by mail wrth the CountyAuditor of the county where the property is located. �-y� ��
Filing Dates: 1) Real Property: During the 12 months before June I7 0/ the year the deduction is to be effective:''a"'
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o(the yea�����s�tq{��gtive.
See �everse side for additional instructions and qualifications.
0
Taxing
Asse�sed valu�oi real
March t, current year
buyer
as oi
on
key number / le al description Record number
����o�������
D�� Page number
Mortgage / Contract indebtedness unpaid as of Is the appli
March 1, current y@ar�!� �/i �� owner?
/ 1 UOf
G
� me soie iegai or
� Yes � No
no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
name on rewrd is different than that of applicant, indicate below: Is the properly in question:
❑ Real Property ❑ Mob�e Home QC 61.1-7)
;me o( moRgagee or contract seller �� ///� ��/ I�
,�'�/
ddress of mortgagee or conVact seller (number a sfreet, city, stafe, ZIP
or
Does applicant own �
county in Indiana?
approv
20 �J
P
Signature
owner on c�
re� and stm
county? I What Taxing District?
DY:IIYCt' 1�'Q.. �� / ..
�
Cat-(� i\'�.
� � .
... � � .....
.......l.O
�ga,�.�i
CV �_
County Auditor
UDITOR
20
Has this deduction been requested on
property tor current year? QYes❑ No
2�
Date
20
I/ We certify under the penalry of perjury that the above and foregoing infortnation is We and correct and that the applicants was / were
�sident of Indiana and owner of the aforementioned property on March 1, 20 . .
�tur` (owners full n� Person authorized by duly executed Power of Attomey
� ��,� or by IC 6-1.1-12-.07
I ruu res�aea[ aaaress or appncan[ Haaress oi aumonzeo person
'� °�s B-� w c 2 5-1 s So.: ii, Q�,..ens�� 112 I