HomeMy WebLinkAboutMortgage_Goodall� T�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
: FOR DEDUCTION FROM ASSESSED VALUATION aCo��{{un Township Year
S J� S�ate Fwm 43709 (R4 / 70.07) � � a F, ,�
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� Presttibed by DepaMienl of Local Govemmeni Finance tl tl
8 ��I
�aN 2 g 2003.
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor o/ fhe county whe�e the property is ocated. (
Filing Dates: f) Real Property: Dunng the 12 months be%re May 11 of the year the deduc� is f��{� e,c����
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and March 3�Ig tlj� ye�, the;de�ge�+ is to be ef/ective.
See reverse side (or additional instructions and qualifications.
Applicant (ownerorcontrac buyer- see restrictions o reverse side)
Taxing Distrid Key number / legal description Rewrd number� �
� �� �/9-aa�9y-s� I�SD�
Page number
Assessed value of real property as of Mortgage / ContraIX indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
dZ�S'000
If no, what is his / her exacl share of interesl? If owned with someone olher lhan 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 pC E1.1-�
�ame of mortgagee or contract seller
�� �
Address of mortgagee or contra seller (number and st2et, ci , stat , Z
Name of assignee or otner owner or holder of mortgage
Address of assignee (number and st�eet, city, state, Z!P code) .
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requesled on
county in Indiana? property for current year? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
zo � zo Zo p� zo � zo � Zo � Zo 0 9
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Signature County Auditor Dale
/ We certify under the penalty of perjury that the above and foregoing infortnation is true and correcl and that the applicants was ! were
resident of Indiana and owner of the aforemenlioned property on March t, 20
Signature (owners /uil name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full resident address of app�cant Address of authorized person