HomeMy WebLinkAboutMortgage_Lofton�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
S� J State Fortn 43709 (R4l 10-01)
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� Presttibe0 by Department cf Locai Govemment Finance �,� �� U ��1 �\� C�
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INSTRUCTIONS: f I Q 3 Z003 File Mark
To 6e filed in person or by mail with the County Auditor o/ the county whe2 the propeRy is loc�t�d
Filing Dates: 1) Real Property: During the 12 months belore May 11 0l the year the deductron is to be eHecGve. n n
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and MarcA 31 0/ the, year`the deduclion,is to be eHective.
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See reverse side (or additional instructions and quali(ca6ons. GI350id COU�T 1' %+'-���TOR
Applicant (owner or n ct buyer- see restri ' s on reverse side) 9 y� 1�1 ��
Taxing Distrid Key number / le description Record number
r ,( / 1 �/O , �[ �G ��� Page number
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Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the appli t t sole legal or equitable
March 1, current year March 1, cunenl year ownef? ❑ Yes ❑ No
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If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of appticant, indicate below: Is the property i question:
❑ Real ❑ Mobile Hane QC 61.1-�
�me of mortgagee or conVact seller i I
Address of mortgagee or conlrad seller (number an treet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and stieet, city, state, ZIP code)
Dces applicant own property in any other If yes, what county? What Taxing District? Has this d udion been requested on
county in Indiana? properiy fo wnent yeaR O YesO No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 S 20 0 20 20 � 20
� � ��'�a P I
Signature County Auditor Date I
�/ We certiTy under the penalty of perjury that the above and foregoing information is true and corred and thatlihe applicants was / were
a resident ot Indiana and owner of the aforemenlioned property on March 1, 20
S� e(owners full me) Person authorized by duly exewted Poi er of Attorney
or by IC 6-1.1-12-.07
u re�n; ress of a i t Address of authorized person �
/� �
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