HomeMy WebLinkAboutMortgage_Straw (2)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
� , Sfafi Fam 43709 (R3 / 70-00) .
,� Presaibe0 by State Board of Taz Commissionexs
Instructionsforfiling:
To be filed in person or by mail with the County Auditor of the couniy where the property is
located during the 72 months before May 11 of the year the dedudion is to be effedive. See
reverse side for additional insWdions and qualifications. �
FORM 5
Coun Township Year
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C�`JNf��^�E.�y' ,r�i�.S !;
Applipnt (oyvpier or contract buy - e 2strictions on reve side) , -
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Taxing Distrid Key number legal des n Record number
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Assess d vatue of al property of Mortgage ! Contrect indebtedness unpaid as of Is the applicant tfie sole legal or equttable
March 1, wrrent year Mar�, curr t ear ' owneR ❑ Yes ❑' No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate vrith whom.
If name on record is different than that of applicant, indicate below:
�e of mortgagee or contrad seller �
Address of mortgagee or contrad selier (number and sheet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, dfy, state, ZIP code)
Does applicant own real property in any If yes, what counry? What Taxing Distrid? Has this dedudion been requested on
other county in Indiana? property for current yeaR � Yes O No
COUNTY AUDITOR
Dedudion approved in the amount of:
y
2o f�'� ,,( Q' zo �_ 20 2o zo Q� zo � 7 zo ��
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Sign re t�Fi County Auditor Date
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I/ We certify under lhe penalty of peryury that the above and foregoing information is true and correct and that the applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners (ull name) Person authorized by duly executed Power of Attomey
• or by IC 6-1.1-12-.07
Fuil resident ddress of appliqnt Address of authorrzed person
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