HomeMy WebLinkAboutMortgage_Collins (7)a .
� a� STATEMENT OF MORTGAGE OR CONTRACT INl7EBTEDNESS
`�`i' FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
J State Fortn 43709 (R6 / 5-06)
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� Presai6ed by Department af Local Gwemment Finarice
NJSTRUCTIONS: AUGF'(� BIa�iOO�
To be filed in person o� by mail with the County Auditor o/ the county where the property is located.
Filing Dafes: 1J Real Property: Dunng the 12 months be%2 ,lune I1 0l the year fhe deduction is to be effectiv
2J Mobile Homes assessed under IC 6-7. 7-7: Between January 15 and March 2 of the year the de� i��effective.
See �everse side for additional instnictions and qualifications. G�gSON COUNTY AUDITOR
Applicant erorconfrdct buyer- see r�strictions on ieverse side)
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Taxing Distrid Key number / legai description Record number ���
��1�� �YO—/�'�8-/O�j —DO� Q��'� Pagenumber S�Ci�
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March i rrent year March 1, wrrent year ownef? �` ❑ Yes � No '
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If no, what is his / her exad s are of interest? If owned with someone other than spouse, indicate wilh whom.
If name on record is different than that of appiicant, indicate below: Is lhe property in question:
❑ Real Properfy ❑ Mobile Home pC 61.1-�
me of mortgagee or coNrad seller
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Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code) � V� � 8[(� �
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Does applicant own propeRy in any other If yes, what county? What Taxing n
county in Indiana? Vo
°�s , TuE �s�
COUNTY AUDITOR
Deducfion approved in the amount of:
20�� 20� 20 20 20 20 20
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Signature County Auditor Date
' We ceAify under the penalty of peryury that the above and foregoing intormation is true and corred and lhal the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature ers full name) ' Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
F reside t address of applicant � � Address of authorized person
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