HomeMy WebLinkAboutMortgage_Minnis�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS —
FOR DEDUCTION FROM ASSESSED VALUATION "�{�� M Coun ;: Township Year
L,� ,
S ! Sute Fortn 43709 (RS / 4-03) � j{ � � ��
�°' 1i
PresaiCed Cy Departmeni ot Loral Govemment Financa
� JUN 1�'" ,
INSTRUCTIONS: � /� �% File Mark
To be filed in person or by mail with the County Auditor o/ the counry where the �erty is�located. �..�1�i���
� r,ir�.,-_
Filing Dates: 1) Real Property: Dunng the 72 mont6s be%re May i1 0/ the year,the,d'eduction�is,to�be'effective.�
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be e((ective.
See reverse side for additional instructions and quali(cations.
Applicant (owneror on ct buyer- see resMcfions on reverse side) . .
Taxing District �Key number / legal description Record number �� .
/( � I D,� � OT I I Page number ,,�� �
lJ J v �-v
Assessed value of real property as of Mortgage / ContraU indebted�ss unpaid as of ' Is the applicant the sole legal or equitable
March 1, wrrent year March 1, wrrent ye2r �! ��D ownefl i❑ Yes ❑ No
%
If no, v.�hat is his / her exaci share of interest? If owned with someone other than spouse, indicate with whom.
If namo on record is difterent than that of appliwnt, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC Cr1.1-�
�Vame of mortgagee or contred seller i
U�_ ,
Address of mortgagee or contract seller (number and street, city, state. ZIP �
Name of assignee or other owner or holder of mortgage i
Address of assignee (number and st�eef, city, state, ZIP code) I
i
Does applicant own property in any other 11; y�s, what co�mty % ��^Jhat Taxing District? Has this deduction been requested on
county in Indiana? i I property for current yeaf.�n Yes❑ No
I '
COUN i Y AUDITOR
Deduction approved in the amount of:
20 20 �� ( 20 � 20 _O� 20 0 20 20
� � _ � P
Signature County Auditor Date
�1/ We certify under the penalty of perjury that the 2bove and toregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March t, 20
n ture (owners (ull name) Person authorized by duly executed Power of Attomey
� or by IC 6-t.t-12-.07
ulI en addres of appli ntCi'��- _- � � /..J� Address of authorized person
(/ O I 1 �
—�—=����