HomeMy WebLinkAboutMortgage_Bollin� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
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� PrescnOed by Department ol Local Govemment Finance �...+ ���� 11 ', y
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INSTRUCTIONS: OCT �`� ZOO4 FileMark
To be rled in person or by mail with the County Auditor ol the county where the property is located. [
Filing Dates: 1) Real Property: During the 12 months belore May 11 0l [he year the deduction is to b��elfective D
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2J Mobile Homes assessed under IC 6-1.1 J: Between January 15 and_Marcb•2�o%!he year tAe;deduction is to 6e effective.
See reverse side for additional instructions and qualifications.
�� Gi°SON CCt'i.� � •,�'- �-
Applicant (owner or con ct buyer- see restricti n reve se side)
Taxing District Key number / legal description Record number O �/
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��^ /(� I � �i �_�'y� Pagenumber �36?
1/V • � V J C..CJ
Assessed value oi real property as of MoAgage / ContraU indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 7, current year March 7, current year owne(? ❑ Yes ❑ No
.�' � �
If no, what is his / her exact share of interest? If owned with someone olher than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
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O Real Property ❑ Mobile Home (IC 61.1-�
��e of mortgagee or contract seller
Address ot mortgagee or contrad seller (number and street, city, stafe, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand strtet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? properiy for current yeaR � Yes � No
COUNTY AUDITOR
Deduction approved in the amount o(:
20 20 � 20 � 20 �� 20 � 20 20
�' P P P
Signature County Auditor Date
We certify under the penalry of perjury lhat the above and foregoing information is true and corred and that ihe applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
Signature ( ners lull name) Person authorized by duly executed Power of Attorney
` • or by IC 6-1.1-12-.07
11 sident address applicant Address of authorized person
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