HomeMy WebLinkAboutMortgage_DixonSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
"-- ' FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
\ y Slate FOrtn 43709 (R4/ 10-01)
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� Prescribetl by DeDartrtient o( Lo:al Govemment F�nance
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�'RUCTIONS: � � � F le Ma
To be filed in person or 6y mail with the County Auditor of fhe county whe2 the property is located.
Filing Dates: 1) Real Property: During the 12 months be/o2 May 11 0l the year the deduction is to b ecfive. '
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0( thC��� th� e"de��uc�t on is to be e/%cfive.
See reverse side Ior additional instructions and qualificatlons. r
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Applicant( er r ntrac uyer-se stncti o re rseside) " �."�"�"• --
Taxing Distrid Key number legal descrip n Record number
D �g-03�3S-0a Pagenumber �C��
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Assessed value of real property as of MoA� / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year Ma wrtent year owneR ❑ Yes ❑ No
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If no, what is his / her exacl share of interest? If owned with someone 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 QC 61.1-�
�me of mortgagee or contrad seller � "�
�ess of mortgagee or contrad selier (number and stre t, city, state, ZIP - —
Name of assignee or other owner or holder of mortgage Drawer NO....Q :3.. ���
Address of assignee (num6erand st�eet, city, state, ZIP code) Card N0.
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Does applicant own property in any other If yes, what counry? i requesled on
county in Indiana? property for wrrent yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 L) � 20 �,� 20 20 � 20 �_ 20 � 20
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Signature County Auditor Dale
�/ We ce' der the penalty of perjury thai the above and foregoing infortnation is true and corted and that the applicants was / were
resid t of In iana and own r of the aforementioned property on March 1, 20
i t r r 1 am Person authorized by duly executed Power of Attomey
. �� or by IC 6-1.1-12-.07
Full esident address of ap � /�� Address of authorized person
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