HomeMy WebLinkAboutMortgage_Arnold (2)e`°rt�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�'"' �: FOR DEDUCTION FROM ASSESSED VALUATION Tow�n7ship Year
S y State Form a37os (Ra / to-01) �"4
u�. 1JPrescribed by Department ol Local Govemment Finance
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INSTRUCTIONS: g������ " ile rk
To be filed rn person or by mail with !he County Auditor o/ the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months belore May 11 of the year the deduction is t --c -
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2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0( the ye r he �e9bc"hbn �rlv tie�effective.
See reverse side /or additional instnictions and quali�cations.
Applicant (owneror ract buyer- see restrictions o revers ide)
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Taxing DisiriIX Key number gal description J Record number
/) � QD� � M Page number
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is lhe applicant the so�e legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned wit omeone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�•ne of mortgagee or contred seller
Address ot mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for current yeaf?O YesO No
COUNTY AUDITOR
Deduction approved in the amount of:
2� " 2��,� 2��/� 2f�� 2• 2��_ 2��
�s 9 � P �
Si ature �9 County Auditor Date
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�' We certify under lhe penalty of perjury that the above and foregoing information is true and correcf and that the applicants was / were
�•,si enl of Indiana and owner of the aforementioned property on March 1, 2!
Sig tur ners full name) Person authorized by duty executed Power of Attorney
or by IC 6-1.1-12-.07
sident address of applicant Address of authorized person
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