Mortgage_Turpin (6)�_�� � STATEMENT iF MORTGAGE �R C�NTRACT INDEE3TEDNESS
`s FOR DEDUCTION FROM ASSESSED VALUATt�N Count Township Year
`'•, , «. �� , State Fortn 43709 (R6/5-06) � T � �
� Presaibetl by Department ot Loral Govemment Finance �
wsrRUCnoNS: JUN 2 �����
To be filed in person or by mail with the County Auditor o) the county whe�e the property is located. �-y,,
Filing Dates: 1) Real Property: During the 12 months before ,lune I1 0/ lhe year the deduction is to be eflgeflv ,6
2) Mobile Homes assessed unde� lC 6-i.1-7: Between January 15 and Ma�ch 2 of the������iY�DI70R �ective.
See �everse side for additional inst�uctions and qualifications.
see
Taxing Dislrid
reverse si¢e)
number 1 legal description � Record number
number
Assessed value oi real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owne(? ❑ Yes ❑ No
8�,�
I( no, what is his / her exad share of interest? Ii owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is lhe property in question:
of mortgagee or contraIX seller
Address of mortgagee or contrad seller'(number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage "
Address of assignee (number and stn
llf-1,����- �to.�GU�.:. 339U
Dces applicant own property in any otl
county in Indiana?
Deduction approved in the amounf of:
20 � 20
q
Signature
C81'C� ti�� . .....................
o,v/� `� 4 a, �cd. o0
20 20 20
County Auditor
�
❑ Real Property ❑ Mobile Home pC 61.
Has this deduction been requested on
property for wrrent year? � Yes� No
20
Date
20
We certify 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 lhe aforementioned propeAy on March 1, 20
of applicant
�
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person