HomeMy WebLinkAboutMortgage_Ice`° rt�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
',' ° �: FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
S / State FOtm 43709 (R4 / 1b01) ��� J� �' \
�� PrescnbeA by Departmenl ot Local Govemmen� Finance 11 % '
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INSTRUCTIONS: �AN 1File?tv��r�
To be filed in person or 6y mail with the County Audifor o/ the county where the property is located.�` 0
Filing Dates: 1) Real Property: Dunng the 12 months belore May 11 0l the year the deduction is to 6�Hectn+� �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of tiie year�he deduction•is�to�be, e/fective.
See reverse side foradditional insfructions and quali�cations.
Applicant (own contract buyer - see restrictio s n reverse side) �
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Taxing Disiri Key number / legal de ption Record number
' L� � �/� )O� �,(�'� Page number �
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Assessed value o al property as of Mortgage / Contract indebledness unpaid as of Is the applicant the sole legal or equitab�e
March 1, current year March 1, current year 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 diKerent than that oi applicant, indicate below: Is the property in queslion:
❑ Real Property ❑ Mobite Home (IC 61.1-�
'' �e of mortgagee or conirad seiier ��
Address of mortgagee or contrad seller (number a t2et, city, state, ZIP
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Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for wrrent year?0 Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
zo� �.ro Zo� Zo 2o zo zo� 20��
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Sig ature County Auditor Date
'�Ne ceAify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
Si nature (owners (ull name) Person authorized by duly executed Power of Attorney
� �� or by IC 6-1.1-12-.07
Full r si nl address f plicant Address of authorized person