HomeMy WebLinkAboutMortgage_Cordray� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
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� Presvibed by Departmeni ot Loc�al Govemment Finance �j � i�
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INSTRUCTIONS: MAY � �pOMark
To be filed in person or by mail with the CountyAUdiror of the county whe�e the property is IocaTeFi: � �
Filing Dates: 1) Real Property: Dunng the 12 months be%re May 11 0/ the year the deduction is,to be elfective. � ��
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2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Maich 2 0( the,y,ear the: deduchon �s-tobe effective.
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See reverse side for additional instructions and qualifications.
Applicant (owne� or cont�act buyer - see restnctions on reverse side)
'✓ � ICt v�be�✓ t'
Taxing Dislrid Key number / egal description Record number O�
QD.C— I I,^�' � Page number I n
V �� � O�
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole lega or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
If no, what is his / her exacl share of interest? It owned with someone other than spouse, indicate with whom.
N
If name on record is diHerent than Ihat of applicant, indicate below: Is tF�e property in question:
6d Real Properfy ❑ Mobile Home QC 61.1-�
"�ame of mortgagee or conlrad seller ��
Address of mortgagee or contract seller (number and street, city, state, ZIP
"1 � 1, V ' J O
Name of assignee or olher owner or holder of mortgage
Address of assignee (num6er and street, ciry, state, ZIP code)
Does applicant ov✓n property in any other If yes, what counry? What Taxing District? Has this dedudion been requested on
county in Indiana? property for current yeaf? � Yes ❑ No
N
COUNTY AUDITOR
Deduction approved in the amount of:
20 � 20 20 (� 20 � 20 � 20 �"Z 20
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SignaWre County Auditor Dale
I/ We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and lhat the applicants was ! were
resident of Indiana and owner of the aforementioned property on March 1, 20
ign t e(owners full na e) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Ful resi ent address applicant Address of authorized person
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