HomeMy WebLinkAboutMortgage_HedgeSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
L�w J State Fam 43709 (RS / 4-03) �
Pre ��ed D rt fL I 1' � 1��
� un �y epa ment o ora Govemment Finance � � y} .�� .�
y3
iNSrRUCnoNS: FE� 2 0 2004 F�ie Ma�x
To be filed in person or by mail with the CounryAUditor of the county where the property is locate
Filing Dates: 1) Real Property: During the 12 montAs before May 11 of the year the deduction is to be e/fective.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ich 2..0�l-.t�h-e yea�the deducf on i�to be effective.
See reverse side for additional instructions and qual�cations. � G� ^ 13SON CfOI�'.' ' aUDt70R �
(ownerorcon/tra�ctbuyer�--�C�[ 2strictionson verseside)
oGL �1 f � \ !\/w..... 0.. �V .. 0
legal
Record number Q
� o / � _ o� /S� Page number I �) ��
/
Assessed value of real property as of Mortgage / Conlrad indebtedness unpaid as of Is the applicant th�'sole legal or equitable
March 1, current year March 1, wrtent year owneR [�Yes ❑ No
�
If no, what is his / her exad share of interesl? If owned wilh someone other than spouse, indicate with whom.
If name on record is different than thaf of appliwnt, indicate
of moAgagee or contrad seller
Address of mortgagee or contract seller (number and s[2et, city, state, ZIP•
in question:
y ❑ Mo6ile Home
-'7q 85
Name of assignee or other owner or holder of �f /� �
j� li-�-i.�J-U�`— � - .
Address of assignee (number and street, city °� "" � J�, �l�
Does applicant own property in an other If `/ �"' `Z' 1��,
Y ) � � Has this deduction been requested on
county in Indiana? ��� �� t �'�� c�,� . � � property for wrtent yea(? � Yes ❑ No
20 �
D
Signature
S.1(J—/^//
in the amount of:
20 0 20
COUNTY AUDITOR
�r;.i�
� I P
County Audilor
zo
Date
zo
I/ We certify under the penalty of peryury that the above and foregoing information is true and corred and thal lhe applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
full
Person authorized by
or by IC 6-1.1-12-.07
` 6 . \ IAddress of authorized person
71 i
of Attomey