HomeMy WebLinkAboutMortgage_BrockSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
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� P2scnEM Cy Department of local Govemment Finance `;
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INSTRUCTIONS: MAY � 20�� Mark
To be filed in person or 6y mail with the County Auditor of the county where the proper;y is located. /
Filin Dates: 1 Real Pro e Dunn the 12 months before Ma 11 0/ the �'` ' � /;
9 1 P Rl'� 9 y year fhe deduction �s to be eflective. , //
2) Mobile Homes.assessed under IC 6-L 1-7: Between January 15 and March 2.of fhe year'the�deduction3s'lo`6e effective.
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See 2verse side for additional inshuctions and qualifications. '
Appticant (owner or co tract b y - see rest ' trons on re � side •
Taxing Distrid , Key number / legal description Record number D� /
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Assessed value of real property as of MoAgage / Contract indebtedness unpaid as of �s the applicant the sole legal or equitable
March 1, wrcent year March 1, current ye2.r owneR ❑ Yes ❑ No
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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 lhat of applicant, indicate below: Is the property in question:
� ❑ Real Property ❑ Mobile Home QC 6-1.1-�
�ame of mortgagee or contrad seller
Address of mortgagee or contract seller (number and street, city, state. 1 �
Name of assignee or other owner or holder of mortgage .
Address of assignee (numberand street, city.,state, ZIP code)
Does applicant own property in any other I I; yes: what counly^ I4^Jh. t Taxing Distnd? Has this deduction been requested on
county in Indiana? I property for current yea� n Yes ❑ No
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COUNTY AUDITOR
Deduction 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 that ihe above and toregoing info�rnation is true and corred and lhat lhe applicants was / were
resident of Indiana and owner of the atoremencioned property on March i, 20
Signature owner's (ull name) Person authorized by duly executed Power of Attomey
� � �� or by IC 6-7.1-12-.07
Full resident address of applicant Address of authorized person
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