HomeMy WebLinkAboutMortgage_Devoy� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�s «� J Siata Pwm 63709 (RS / 4-03) . � - � � . .
� PrescnbeE Oy Departmeni of Local Govemmem Finance
INSTRUCTIONS:
To 6e filed in person or by mail with the County Auditor ot the county where the propeRy is loca!
Filing Dates: 1) Real Property: Dunng the 12 months be(ore May 11 0/ the year the deduction is ro oe enecnve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deducfion is to be e((ective.
See reverse side 1or additional instructions and quali�cations.
rNpm:an� �uwner or comracr nuyer- see resmcnons on reverse s�c
iu�11x a' \ ([,(��Q
Ta�nng Disirid Key number / le�
Record
Page number
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Assessed value of real p�Iperty as of MoAgage / Contrect indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, current year March 1, wrrent year ownef? �es ❑ No
gDOo d
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 applicanl, indicate below: Is the property in question:
❑ Mobile Horrie (IC 61.1-�
of mortgagee or contract seller
Address of mortgagee or wntrad sel%r (number and street, city, stafe, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sfreet, city, state, ZIP code)
Does applicant own property in any other If yes, what wunry? What Taxing District? Has this deduclion been requested on
county in Indiana? property for current year?Q Yes� No
Deduction approved in the amount of:
20 20 _��_ 20 �
t P
Signature
COUNTY AUDITOR
�3�]
County Auditor
20
�
Date
20
certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
'ent of Indiana and owner of the aforementioned propeAy on March 1, 20
name)
Person authorized by duly executed Power
or by IC 6-1.1-12-.07
of authorized person