HomeMy WebLinkAboutMortgage_Shoultz (5)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS ��� �
` FOR DEDUCTION FROM ASSESSED VALUATION Coun" ; 6I To shid Year
�s N� / Stare Fwm 43709 (RS / 4O3) �� �
+� ny CTi
� PrescriDed by Depanment of Loral Govemment Finance JU N 2 :�'¢UDU�
�r ., y�
INSTRUCTIONS: ��� 'a'File�Mark
To 6e �led in person or 6y mail with the CountyAuditor of the county where the propeRy is Iocated.SON COUNTY AUDITOR
Filing Dates: fJ Real Property: During the 12 months 6efore May 11 of the year the deduction is to be elfecfive.
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0l the year the deduction is to be elfective.
See reverse side /or additional instructions and qualificafions.
Distrid
March 1, current
If �io, what is
or contracf buyer - see restrictions on reverse side)
as of
exact share of interest?
If name on record is different than thaf
of mortgagee or contrad
Key number / legal d�// Record number � M�
v LC/
�1G-az-ia -ido-cao.83a-oi�
O— B _ Page number
Mortgage / Contrad indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, current year owne(? �es ❑ No
�� V
If owned with someone other lhan spouse, indicate with whom.
indicate below:
Address of mortgagee or conlrad seller (number and sbeet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (num6er and sUeef, city, sfate. ZIP code)
Does applicant own propeRy in any oihor If ��P,., what county? What Taxing Distrid?
counry in Indiana?
7'�' � �.,. T / < _ . _i,r COUNTY AUDITOR � �_
r� i
approved in ihe amounf
20 �� 20 _� 20 �
P �
_ County Audifor
Is
❑ Mobile Home (IC 61.1-�
Has this dedudion been requested on
property for currenf yeaf? �] Yes ❑ No
20
Date
20
/ We cehify under Ihe penalty of perjury that ihe above and forogoino information is true and corred and ihat the applicants was / were
1resident of Indiana and owner of thP aforementioned propeRy on March 1, 20
address
Person aulhonzed by duly executed Power of Attomey
or by IC 6-7.1-72-.07
of authorized person