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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION s� Year
'' ,.,, � s�teF«R,<s��cRS�<�.,, DEC 2 8 2005
� PrescriAed by Departm�nt ol Local Govemment Finance
INSTRUCTIONS: o/r°� `a�y�
To be Fled in person or 6y mail with the CountyAUditor o/ the county where the propeRy is locafel$SON COUNTY AUDITOR
Filing Dates: 1J Real Property: Dunng the 12 mon[hs before May 11 of tbe year the deduction is to be eflecfive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the year fAe deduction is to be ef(ective.
See reverse side /or additional instnictions and qualifications.
cestric[ions on ieverse
Dislrid
Assessed value of real property as of
March 1, current year
If �io, what is his / her exact share of interesl?
Key number / legal descriplion
number
_O �� o� _�O I Page number ,7 � a
n
MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneft �Yes ❑ No
�a 00
� If owned with someone other than spouse, indicate with whom.
If name on record is different ihan that of applirant, indicate belnw:
�me of mortgagee or contred seller
Address of mortgagee or contract seller (nu �h r and street, city, statM � P
Name of assignee or other owner or holder of moAGaqe
/+dtlress ot assignee (numtrer and stresl. city, srate. ZIP code)
Does applicant own nroperty in any oth�r
wunry ir, Indiana?
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:••hat cnunry? �
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Deduction appro•Jed �n the amo�n,� nt:
20 �_
COUNTY AUDITOR
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___ _ County Auditor
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❑ Mobile Home QC 61.1-�
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20
Date
� requested on
�R� Yes❑ No
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1h�r. re�tihj unde�!h� p:�:,alty of perynr� �h,� tt,o above and foreaoina informaGon is �m? and corred and that the applicants was /were
esioent of Indiana ?nd owner o( tha afrneo�entioned property on March 1. 20 __
resident
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ss of aoolirant
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Person a�dhnrized by duty executed Power of Nttomey
orbylG 6-1J-I�-_07
Address of authonzed person