HomeMy WebLinkAboutMortgage_Bishop�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
` j State Portn 43709 (R4 / 70-01)
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� PresaiWd b� DePaRment W Local Govemment Finance
INSTRUCTIONS: � �� File �
To be filed in person or by mail with the County Auditor of the county where the propeRy is loc d.
Filing Dates: 1) Real Property: During the 12 months befo2 May l i o! the year the deduction is to be e ec i
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0l the the is to be effective.
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Applicant(owneror ctbuyer-see 'c6onson verseside) 'S•�N�•�J�ivqUDITOP,
Taxin Di�trid Key numbe / legal description Record number O�_ p� `'
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Assessed value of real property as of Mortgage ! Contred indebtedness unpaid as of Is ihe applipnt the sole legal or equitabie
March i, curtent year March 1, current year owneR ❑ Yes ❑ No
If no, what is his / her exact share of interesl? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Prope�ty ❑ Mobile Home pC 6-1.1-�
e of mortgagee or contract seiler
Address of mortgagee or contract seller (number and street, city, state, ZI
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Dces applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
counly in Indiana? property for wrrent yeaf? � Yes ❑ No
COUNTY AUDITOR
Dedudion approved in the amount of:
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Signature County Auditor Date
�� We certify un r e penalty of perjury that the above and foregoing infortnation is true and corred and lhat the applicants was / were
resident of In ia a and owner of the aforementioned property on March 1, 20
Sign�ture (o �(ull name) Person authorized by duly executed Power of Attomey
�� � or by IC 6-1.1-12-.07
ull residen address of appliqnt .C/NCG�ia/V Address of aulhorized person
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