HomeMy WebLinkAboutMortgage_Grishamrt�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION �� u 7ownship Year
�• ! State Form a37091R5/ a-03)
� PrescnDeE �y Department of Laal Govemment Finance
` MAY 0
INSTRUCTIONS: File Mark
To be filed in person or by mail with the CountyAUditor of the county where the property'�',�te�
Filing Dafes: 7) Real PropeRy: During !he 12 months before May 11 0/ the year the deduction�to be
2J Mobile Homes assessed underlC 6-7.1-7: Between January 15 ar�188�Q1A ��WII���a et��eduction is to be eNective.
See reverse side !or additional instructions and qualifications.
cont2ct buyer- see res 'tacjjpn�on reverse side)
i axmg uistna Key number / legal description, Record numb�
QD�� Q � � �O,OT Page number
�.J
Assessed value of real property as of Mortgage / ContraG indebtedness unpaid as of Is the ap{
March 1, wrrent year March 1, current year owner?
� J ��
�_J
t the sole legal or equitable
❑ Yes ❑ No
If no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate with whom.
I( name on record is different than that of applicant, indicale below: Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
�me of mortgagee or ontract seller , �
Address of moRgagee or contract seller (number an treet, city, state, ZIP / .
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, sfate, ZIP code)
Does applicant own property in any other I If yes, what wunty? I What Taxing Disirict?
county in Indiana?
Deduction approved in the amounf of:
20 Q� 20 n' 20 �
� �
Signature �
COUNTY AUDITOR
20 � 20
Couniy Auditor
Has this dedudion been requested on
property for wrrent year? � Yes� No
20
Date
20
' We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the atorementioned property on March 1, 20
Person authorized by
or by IC 6-1.1-72-.07
resident address of appliwnt IAddress of authorized person
Attorney