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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
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To be filed in person or by mail with the County Auditor of the county where the property is located. / i /� n
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 of the year the deduction?s to be effectiveYr,�,��,�¢_y
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the, year•t'he:deduction; is'fo be eRective.
See reverse side /or additional instructions and qualifications. �gSON C0�!" �' '
buyer - see restrictions on reverse
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Assessed value of real property as of
March 1, cunent year
If no, what is his / her exact share of
If name on record is different than
r
of mortgagee or wntrect
number / legal description
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Mortgage / Contract indebtedness
March 1, curtent year
`
below:
I Record number
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Page number
as of Is the applicant the;ole legal or
owner? �'%s ❑ No
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If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contrect seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sVeet, city, state, ZIP code)
Does applicant own property in any other If yes, what counry?
county in Indiana?
Deduction
20
Signature
,,� a
the amount of:
20 �
�
Is
❑ Mobile Home (IC E1.
What Taxing District? Has this deduction been requested on
property for current year? ❑ Yes� No
COUNTY AUDITOR
20 FI % 20 ��'
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County Auditor
20� I 20
Date
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certify under the penalry of perjury that the above and foregoing infarmation is true and cortect and that the applicants was / were
fent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
�II re'sident address of applicanC p X Address of authorized person
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