HomeMy WebLinkAboutMortgage_Matselr�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'�i� FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
��.w y StateFortn43709 (R6/5-06)
Presrnbed by Depariment of Lo�al Govemmenl Finarice
To beRil edTIOP Sson o� by mail with the County Audito� of the county where the properfy is loc�� ��e�
Filing Dates: 1) Real P�operty: Du�ng the 12 months before ,lune I1 0l the year lhe deducfion is to be eflective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the ��1th� d�dQ� is fo be e/(ective.
See reverse side for additional instnictions and qualifications.
. � �la� .Q�,
Applicant (owner
see
Tauing D'strid
Assessed value of real property as of
March 1, wrrent year
Key number / legal e cription
a'G-i1-o� �s�oa�. �%a�oaa
O / �-DO �a ��
Mortgage / Contrect indebtedness
March 1, current vear
OQoC�
. _'".. ""vrv � r AUDI70R
Record number O
Psae number �
as of I Is the applicant the sole legaf or equitable
owne(? ❑ Yes ❑ No
Ii no, what is his / her exad share of interest? If owned with someone olher than spouse, indicate with whom.
If name on rewrd is different than that of appticant, indicate below: Is the property in queslion:
� ❑ Real PropeAy ❑ Mobile Home QC 61.1-�
me of moAgagee or contract seller ��
Address of moRgagee or contrad seller (number and stieet, cit , state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applipnt own property in any ofher � If yes, what counry? _
county in Indiana? .
Deduction approved in the art
20
Signature
20 e�
MaTs t� pf.�19y�E
O� ����4
�
County Auditor
Taxing Distrid?
fOR
+3�7
Has lhis dedudion been requested on
property for wrrent yeaf? � Yes ❑ No
20
20
We certify under the penalty of perjury lhat the above and foregoing information is true and correcl and lhat ihe applicants was / were
resident of Indiana and owner of the aforementioned properiy on March 1, 20
full name)
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
of applip�tV �Address of authorized person