HomeMy WebLinkAboutMortgage_Jones (7)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION
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� Presaibetl by State BoarC o1 Taz Cortunissioners
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Instructions for filing:
To be filed in person or by mail with the County Audftor of the county where the property is
located during the 72 moMhs before May 11 of the year the deduction is to be effective. See
reverse side for additional instrudions and qualfications.
Applipnt
Taxing
or cont2ct buyer - see restnc ' ns on reverse side) .�
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Key number / legal description
Assessed value of real property as of
March 1, current year .
no, what is his / her exad share of interest?
name on record is different than that
FORM 5
Cou Township Year
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MAY 19 2001
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Page number
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Mortgage / Contract indebtedness unpaid as of Is the applipnt t e al or equitabie
March 1, current year _ owneR ❑ Yes � No
(/ J J `/ . -.
If owned with someone other than spouse, indicate with whom.
below:
�e of mortgagee or contrad seller Q��
Address of moRgagee or conVad seller (number and street, city, state, ZIP
�Q��_�
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st�eet, aty, state, ZIP code)
Does applipnt own real property in any If yes, what county? What Tauing DisVid?
other county in Indiana?
amount of:
2o n� . 13,01 Zo�1�
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COUNTY AUDITOR
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County Auditor
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Has this deduction been requested on
property for wrrent year? � Yes� No
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ceRiy under the penalty of perjury that the above and foregoing infortnation is W e and corred and that the applicants was / were
lent of Indiana and owner of the aforemenGoned property on March 1, 20
�ire owners full name Person authorized by duly executed Power of Attomey
,,,,, „Y „. _ � , _ 0,�,- or by IC 6-1.1-12-.07
Full resident addreu of applicant �Address of author¢ed person