HomeMy WebLinkAboutMortgage_White�'�'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-° ' FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
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� Prescribetl Dy Depanrtrenl W Local Govemmeni Finance II��,N
MAR � 7 2003
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county whe2 the properfy is located. //
Filing Dates: 1) Real PropeRy: Dunng the 12 monfhs be%�e May 11 0/ fhe year the deduction is to be ef/ective � //
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2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0l the yea� tFre ucUOn.�.s-to 6e,e(te�e.
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See reverse side for additional instiuctions and qualifications.
Applicant (owner r ontract buyer- see res ' ions on reverse side)
Tauing Distrid Key number / legal d ription Record number D�
O�`�y��C // // i. (r/ �/�n�Q Page number 4
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Assessed value of real property as of MoRgage / Contred indebtedness unpaid as of Is ihe applicant the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
S�g, v�ro
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 lhan ihat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Hmie (IC G1.1-�
�ame of mortgagee or contrad seller �
Address of mortgagee or contrad seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? VYhat Taxing District? Has this dedudion been requested on
county in Indiana? property for wrrent yeaf?� Yes❑ No
COUNTY AUDITOR
Dedudion approved in the amounf of: �
20 20 20 20 �� 20 � 20 �� 20 0 9
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Signature County Auditor Date
1/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
� resident of Indiana and owner of the aforemenlioned property on March 1, 20
Signa re ow ers n me Person authorized by duly executed Power of Attomey
or by IC 6-1�.1-12-.07
u r ent add s of applipnt Address of authorized person
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