HomeMy WebLinkAboutMortgage_Martin (28)�
STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�' M-�' Siate Fortr: 63709 (RS I a-031 �
-� ,, � . PresfnDed Ey Departmeni of Local Govemment Finance �
INSTRUCTIONS: � /-IF't( 2 gil�rMark
uU7
To be (led in person or by mail wrth the County Auditor of [he county where the property is located.
Filing Dafes: 1) Real Property: During the 12 months before May 11 0/ the year the deduction is to be��ff ive.
� 2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the yea%tHEdygd��'s to be effective.
GIBSON ��
See reverse side4or additional instructions and qualifications. COUNTY qUDITOR
nt (owne or contract buyer - see restrictions on re erse side) ,
,� °�
Taxing District Key nu ber / legal description Record number
� . ^ Q � � � _ e Page number
Assessed value of real property as of Mortgage / ContreU indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? �es ❑ No
I6
If no, what is his / he[ exact share of interest? If owned with someone olher than spouse, indicate with whom.
If name on record is differeN than that of applicant, indicate below: Is the property in question:
�' eal Property ❑ Mobile Home (IC frt.1-�
me of mortgagee or contract seller
Address of mortgagee or contract seller (number and street, city, sfate, ZIP
Name of assignee or other owner or holder of morigage
Address of assignee (number and stieef, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
counry in Indiana? property for current year? �] Yes❑ No
� _ O NTY AUDITOR
Deduction approved in lhe amount oL
20 20 �/ � 20 O�' 20 �_ 20 20 20
�
Signature� County Auditor Date
We certify under the penalty of perjury thal the above and foregoing information is true and corred and that lhe applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20 �
ture (own rs 11 name) Person authorized by duly executed Power of Attomey
'�� or by IC 6-1.1-12-.07
ull resident address of applicant Address of authorized person
�
I¢/ S i� Yi