HomeMy WebLinkAboutMortgage_Tice,'a` � STATEMENT OF MORTGAGE OR CONTRACT INiiEBTEDNESS
�i'�; FOR DEDUCTION FROM ASSESSED VALUATION Co-7u�nt Ta+vnship Year
�J, State Fortn 43709 (R6 / 5-06) �
� Prespibed by Departmeni of Local Gwemmen� Finance
INSTRUCTIONS: /�U�.�l Ma�00%
To be tiled in person o� by mail with the County Auditor of the county whe�e the property is localed. �-y� �
Filing Dates: 7) Real Property: Du�ng the 12 months be%re June 11 of the year the deduction is to be e%ctive'l'�
2J Mobile Homes assessed under IC 6-1. 7-7: Between January 15 and March 2 0/ the year���Clg�.r���i k@�08ive.
See reverse side fo� additional instructions and qualifrcations.
or contract buyer- see restrictions on
Taxing
Assessedvalue of real(�roperly as of
March t, ciurenl year
no, what is his / her exact share of interest?
Ii name on record is tlitterent Ulan that
ot mortgagee or contrad seller
Address of mortgagee or conVact seller
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Key numbe / legal description � Record number
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� � � 7 r0 Page number .
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MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or e
March 1, current year owne(? ' � Yes ❑ No
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it, indicate belo�
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and street, city,
Name of assignee or olher owner or holder of mortgage
Aatlress oi assignee (num6er antl st2et,
Does applicant own property in any other
county in Indiana?
ueaucnon approvetl m the amount of:
20 �fL
Signature
state, ZIP code)
If yes, what county?
cour
20 �� � 20 I 20 _
County Auditoi
We certity under the penalty of perjury that the above and fore�
esident of Indiana and owner of the aforementioned property o
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Person authorized b�
or by IC 6-1.1-12-.07
of authorized person
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