HomeMy WebLinkAboutMortgage_GambrelC� rt•n � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESc
'�-° .: FOR DEDUCTION FROM ASSESSED VALUATION
S�y Slate Form a37os (Ra i tao�)
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Prescribetl by Department of Loc�al Govemment Finance
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INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o( the county wheie the property is
Filing Dates: 1) Real Prope�ty: During the 12 months be(ore May 11 o/the year the deduction is to bP��c�y� Z��L
2) Mo6ile Homes assessed under IC 6-1.7-7: Between January 15 and Marcfi� 31 0/ the year the deductio
See reverse side 1or additional instructions and quali�cations. r � y] ..
buyer-see
Distrid
Assessed value of real property as of
March 1, current year
no, what is his / her exact share of interest?
If name on record is different than that
Y
reverse side)
Key number / legal description � Record number
to be elfective.
v uc
O 1�_GO I��_ � Page number
MoRgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year owner? ❑ Yes ❑ No
50 000
If owned with someone other than spouse, indicate with whom.
indicate below:
�ie of mortgagee or contrad seller �r ►1 � �., p�
Address of mortgagee or contrad seller (number and sfreet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st�eet, city, state, ZIP code)
Does appticant own property in any other If yes, what counry?
county in Indiana?
Deduction approved in lhe amounf
20���'�� I 20b'!,
�5
What Taxing District?
COUNTY AUDITOR
s the property in question:
� Real Property ❑ Mobile Home (IC &1.1-�
Has this deduction been requesled on
property for current year?� Yes� No
� � ♦ ��J_6� '��
zo ��
ue (�7 ' County Auditor I uaie
/
certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
lent of Indiana and owner of the aforementioned propeRy on March 1, 20
q�e (owner's full name� � Person authorized by duly executed Power of Attomey
�'-t"� _. 1l .[/ I or by IC 6-1.1-12-.'�7
WtlWl�l. �,b �XI�Yii
rull residenl .ddres oTapplicant Address of authonzed