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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION Township Year
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� PmscnOed by Department of Loral Govemment Finance
�NSrRUCnoNS: JUN 0 6 2006
File Mark
To be filed in person or 6y mail with the County Auditor of the county where the property is located. �
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 0l fhe year the deduction is to�b�ll�effDe.
2) Mobile Homes.assessed under IC 6-1.1-7: Between January 15 and March 2��0r�qe�p�d��yy�to be eNective.
See reverse side /or additional instructions and qualifications.
Applicant (o�er or contracf buXer see resMction�,on reverse side) �
Taxing Distrid //
/ �/� � W�-0�i��
Assessed value of real properly as of
March 1, wrrenl year
If no, what is his / her exaci share of interest?
Key number/�gal description
0/� �9g- �
Mortgage / ConfraG indebtedness unpaid as
March 1, wrrent year
If
If name on record is difterent than that of applicant, indicate below:
�me of mortgagee or contrad seller
Address of moAgagee or contraIX seller (num�an� ef, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (numberand street,
Does applicant own property in any c
C A �2�a/ �°Y �
�Glc� �=
b�-aaa�
2� � _ ( �� _�.,�
Signature
state, ZIP code)
If yes, what counry?
Record number
Page number
Is the applicant the solelegal or
ownef? ❑ Yes ❑ No
with someone ather fhan spouse, indicate with whom.
What Taxing District?
COUNTY AUDITOR
__ 20 20
P
_ County Auditor
s the property in question:
❑ Real Propeity p Mobile
61.
Has this deduction been requested on
property for current year? �] Yes ❑ No
�
Date
20
We ceAity under the penalty of perjury that the above and foregoing intormation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
name)
,
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Full resident address of applicant " Address of authorized person
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