HomeMy WebLinkAboutMortgage_Nelson`°rt�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S / State Fortn a37os (R4 / 7a07)
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� Prescribe0 by Depanmen� of Local Govemment Finance � `
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INSTRUCTlONS: � � �� ,• � File Mark
To be �led in person or by mail with the County Auditor of lhe counfy where the prqpgqy ys l�o'caj���
Filing Dates: 1) Real Property: During the 12 months belore May 11 of the year th��Hc�iludti r� e eflective.
2) Mobile Homes assessed under IC 6-1.1J: Befween January 5 and March 31,of the ynear the deduction is to be eHective.
See reverse side /or additional instnictions and qualifications. f���� /�
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GI4SONO�i���`' ^UDITOR
Applicant (owne�or,c ntrac bu er- see restnctio n r sid
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Taxing Distrid number / legal description Record number �
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Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned wilh someone other lhan spouse, indicate with whom.
If name on record is different than ihat of applicant, indicale below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�me of moRgagee or conlrad seller (� `
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Address ot mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what co�nry? What Taxing District? Has this deduction been requested on
counry in Indiana? property for curtent year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �,� 20 20 � 20 � 20 J� 20 � 20
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Signalure County Auditor Date
/ We certify under lhe penalty of perjury that the above and foregoing infortnation is lrue and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on Marcn 1, 20
natu (owners (ull name) Person authorized by duly executed Power of Attomey
Oor by IC 6-1.1-12-.07
I sid n ess f applicant — Address of aulhorized person
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