HomeMy WebLinkAboutMortgage_Meadowsia?�—��
i i � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
1\i : FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
`�: J� State Fwm 43709 (R6 / 5-06) �� .
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� Presaibed by Department of Loml Gwemment Finance
INSTRUCTIONS: AUG 2 1 Z��� Mark
To 6e filed in pe�son or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: DuAng the 12 months before ,lune �7 0/ the year the deduction is to ba�/jective.
2J Mobile Homes assessed under IC 6-1J-7: Between January 15 and March 2 o/the ��Rfrs�n is to be effective.
See reverse side foradditional instn�ctions and quali�ications. G�BSON COUN7Y AUDITOR
(owne�
Assessed value of real
March 1, wrrent year
buyer
as of
If no, what is his / her exad share of
resMctions j�n reverse side)
Key number / legal desuiption Record nuinber �
�6 -� �- �9- /Ov- p, Page number
O / (o/O-OoZ/
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or e
March i, current year ownef? ❑ Yes Q No
�Q�0�0
If owned with someone other than spouse; indicate with whom.
If name on record is different than that of applicant, indicate below:
�me of moRgagee or contract selleC�� Y_��
Address of mortgagee or contrad seller (num r and street, dty, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applipnt own property in any other If yes, what counry? What Taxing Distrid?
county in Indiana?
approved in the amount of:
20 � � 20
COUNTY AUDITOR
20 20 20
County Auditor
s the' `_ nnws
❑Res ' ` eQC61.
�' ' ,
Has lhis dedudion been requested on
property for wrrent yea�'?� Yes❑ No
20
Date
�
certify under the penalty of perjury lhat the above and foregoing information is true and corred and lhat the appiicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
ire ners full name) �-A Person authorized by duly executed Power of Attorney
/tilw .i /.l % I"//i ��i.... e or by IC 6-1.1-12-.07
n Naaress or aumonzea person
S�OS D�U��;/�