HomeMy WebLinkAboutMortgage_Halbig (11),,,EF?•^4 STATEMENT OF MORTGAGE OR CONTRACT
a'�`Ay `= INDEBTEDNESS FOR DEDUC=T1°"'�ASSESSED
"� a`' VALUATION Ste'J� a�a� i nbed by the
� State Board of T� �� 9� �
� � GLfi���'
FORM 5
Filin fee $1.00 �
Counfy Township Year
� ��,,--�) =r=�t-.; File,M�ark
Instructions for filing: ��A-L"" "", k'� ��' ; I� r p tl
To be filed in person o.r by mail w ounty where the.:� ._. ,,,,,y�y
property is located during the 12 n ar the deduction ��1, i�o
is to be effective. See reverse for _....., yualifications. Zl��l�
Assessed value of real property as
of March 1, current year
Key Nu e egal Description ,
:� 9-�_aa���
Mortgage/Contract IndebtecJness
as e€�'ar�fy j:,cu�renLyear.
If no, what is his/her exact share or interest?
C i=, ^;�
Record No.
No.
is��
Is the applicant the sole legal or
equitable owner? O yes +> no
If owned with someone other than spouse,
indicate with whom.
If name on record is different than that of.applicant, indicate below:
of mortgagee or contract seller
Address of mortgagee or contract seller
Name of Assignee or
of Assignee
owner or holder of Mortgage.
a
Does applicant own real property If yes, what county? What Taxing District? Has this deduction been
in any other county in Indiana? requested on property for current
year? O yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
Year�, Year B� Yea� Year�ib� Y�� Ya�a.Q� Year�
. d-at �
Signature 0 Secretary of Board of Review Date
P P
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the
�cants was/were a resident of Indiana and owner of the aforementioned property on March 1,
full
Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07).
R� ent A�� of Applicant Address of Authorized Person
/ D �Ql�