HomeMy WebLinkAboutMortgage_Snodgrass`° rt�"o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
"' • FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
S J State Fwm 43709 (R4 / 10-01)
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Prescribed by DeDartment of Loral Govemment Finance
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INSTRUCTIONS: � � (i Fi Mark �
To be filed in person or by mail with the County Auditor of the county whe2 the propeRy is locat �/ ��.
Filing Dates: 1) Real PropeRy: During the 12 months befoie May 11 of the year the deduction is to be eHective.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 of the ye�`rllhe Efed6c�1�� to be effective.
�ee 2verse sae ror atltlrnonal instruc6ons antl quallfica6ons. .���J '� D
ca 1(owneror¢ont uyer-see dions nreversesrde) ' "' OU�TYq(+p�TO`r. .
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Tauing Disirict Key number / leg description Record number �
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A sesse vatue o re property a Mortgage / Contrad indebtedness unpaid as of is the applicant the sole legal or equitable
March 1, curcent year March 1, current year ownef? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate wilh whom.
If name on record is different than that of applicanl, indicate below: Is the property in question:
� Real Properiy ❑ Mobile Home pC 6-1.1-�
�ame of mortgagee or contract seller
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Address of mortgagee or contracl seller (number and st2et, city, stat , ZIP
Name of assignee or other owner or holder of mortgage
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Address of assignee (number and st�eet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for current yea(?� Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � 20 20 20 Q(� 20 D� 20 �� 20 �_
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Signalure County Auditor Date
I/ We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that ihe applicants was / were
residenl of Indiana and owner of the aforementioned property on March 1, 20
Signat owner 11 e) Person authorized by duly executed Power of Attomey
y— or by IC 6-1.1-12-.07
Full r� ,s1ident address of plicant Address of authorized person
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