HomeMy WebLinkAboutMortgage_Morris (4)ii�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i'�; FOR DEDUCTION FROM ASSESSED VALUATION Co own ' ear
'v ,� • SUte Fwm 43709 (R6 / SO6)
� Presoibed by Depanmenl of Local Govemment Finance
INSTRUCTIONS: �e Ma�c
To 6e filed in person or by mail with the County Auditor of the county where the propeRy is located. a�(/
Filing Dates: 7) Real Property: Dunng the 12 months 6efo2 ,lune 17 of the year lhe deduc6on is to be e/f�pN Cp�NTY AUDITOR
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to 6e elfective.
See 2verse side /or additional instnictions and quali(rcatrons.
Appliwnt (ownerorcontract b�yer-see restn 'ons on reverse side)
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Taxing Distrid Key number / legal description Record number
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3 5� 9- o a.. o Page number �� 6'
Assessed value of real properly as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, curtent year owneR ❑ Yes ❑ No
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I( no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diiferent than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mohile Home pC 51.1-�
e of moRgagee or contract seller J/�
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Address of mortgagee or contrad seller (number and street, aty, state, ZIP
Name of assignee or other owner or holder of mortgage �1 r7
Dra�rer NO.. .�°{..�..L.......
Address of assignee (number and street, city, state, ZIP code) G�! I
Card NO. J ��
....... .......
Does applipnt own property in any other If yes, what counry? What �tr ��Q, � ed on
county in Indiana? ;❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �� 20 Q� 20 20 20 20 20
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Signature County Auditor Date
We certify under lhe penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
sideni of Indiana and owner of the aforementioned property on March 1, 20
y gna e(owners /ull name) Person authorized by duly executed Power of Attomey
/` � P ,. � or by IC 6-1.1-12-.07 .
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Full resident address of applicant Address of authorized person
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