HomeMy WebLinkAboutMortgage_MarshSTATEMENT OF MORTGAGE OR CO�RA�CT INDEBTEDNESS
' s FOR DEDUCTION FROM ASSESSE[� VA �UATION'� � Coun Township Year
S � J State Pam 43709 (R4 / 10-07) j1J ( •
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� PresuibeC by DepaNrent of Local Govemment Finance � uro 2 p Zp03
INSTRUCTIONS: /.��J�-c.� l.l. l! File Mark
To be filed in person or 6y mail with the County Auditor of ttie:coLnty�wheie�the p,rope�"�s located. � ��� �� �
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ the yea� tfie deduction is to be eHec ' e�
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ the year the deductia+•is�t� H'.
See reverse side /or additional instnictions and qualifrca6ons ����2003
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Applicant(own rorc ntra buyer-see ric son verse ' � �/
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Taxing Distrid Key number / legal description Record number /�'� 1� �
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I 7� 00 I/► V3�O� Q �/^i r� \ � �/ 1 Page number �„� 1 u Z�03
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the apphcant the sole legal,or equitable
March 1, current year March 1, cunent year owneR 4, � Yes-� N�
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� 0 O O ' c��.:'..n C. JN i 1' AUDITOR
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Horne pC 61.1-�
' me of mortgagee or contred seller �
Address of mortgagee or conVact seller (number and st2e , aty. state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sheet, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Tauing DistriIX? Has this deduction been requested on
county in Indiana? property for curtent yeaf? � Yes � No
COUNTY AUDITOR
Deduc6on approved in the amount of:
20 20 20� 20 ��/ 20� 20�_ 20
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Signature County Auditor Date
/ We certify under the penalty of perjury lhat the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Sign e(owners Iull name) Person authorized by duty executed Power of Attomey
� or by IC 6-1.1-12-.07
ull resident addre s of applicant Address of authorized person
3 0 3 C'e A;�I �"7; e�s u+y'll�.