HomeMy WebLinkAboutMortgage_Peil��� y STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
«. J State Fam 43709 (R6l 5�06) y� ; � �
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� Presaibed by Department of Loral Gmemment Finance _ ��
s:t .'.J
INSTRUCTIONS: �i�y'�qy}�1 ZOOH
To be filed in person or by mail with the County Audrtor ot the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months before June Il of the year the deduction is to be effective. ;?'?�� ,�
2) Mobile Homes assessed unde� IC 6-1.1-7: Behveen January 15 and March 2 0/ the yea� the deduction i� be �ctive.
G755GN CCUNTY AUDITOR
See �everse srde for additional instrucfions and qualifrcations.
(owner or contract buyer -
in.� n ql rI.
Taxing Dislrict
Assessed value of real property as of
MarcF� 1, wrrent year
If no, what is his / her exad share of
vo�n �rse smey) �
Y�L�/
Key number / iegal description
o�6-oa - 59- o3a -
C700. x- �l `f-O / `
Mortgage / Contrad indebtedness unp
March 1, curtent year
� d. a0 C7
Record number
�oa
Page number .��
as of
Is the applipnt the sole legal or equitable
owneR ❑ Yes ❑ No
If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
�e of mortgagee or contrad seller �
Address ot mortgagee or contrad selier (numbe and st2et, aty, state, ZIP
Name of assignee or other owner or holder of mortgage
❑ Madle Home QC 61.1-�
Address of assignee (numberand stieet, ciry, state, ZIP code) Dl',
�wcr t\'O.�Oo�"^;395"
Does applipnt own property in any other If yes, what county? WI ��'
county in Indiana? C� 1"C� 1��� . .................... .
COUNTY AUDITOR
)eduction approved in the amount of:
20 � 20 � 9 20
P P
20
County Auditor
20
20
Date
f
i
j equesled on
j� � Yes � No
t
i
E
�
i
20
certify under the penalty ot perjury lhat the above and foregoing infortnation is true and corred and that Ihe applicants was / were
lent of Indiana and owner oi the aforemenlioned property on March 1, 20
� Sign�e (owners�me)
`
Full resident ddress of applicant
I i� /o Y�= ��„ 1 r�
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
authorized person