HomeMy WebLinkAboutMortgage_Hardiman (6)`9" � STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION K'Coun Township Year
• ,�� ♦ s�ate F«m aa�oe (R5 � a-0a) � li1 �
� ' PresaiEed Dy Depanment ol lacal Govemment Finance �� �
�.J
INSTRUCTIONS: SEP 3 O ��a�
To be filed in person oi by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: Dunng fhe 12 months before May 11 of the year the deduction is to be elle'�,ve.�r�
2) Mobile Homes assessed under IC 6-7.1-7: Between January 75 and March 2 0/ tAe ear the3educt�on is to be eRective.
See reverse side for additional instructions and qualifications. G�B�ON COUNTY AUDITOR
Taxing
(owner
CJ
Assessed value of real property as of
March 1, current year
restnctions on reverse side)
Key number / legal description Record number G� ��
O/Q, �a / Q`J� � Page number n
`Y d�
Mortgage / Contrect indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year � owner? ❑ Yes ❑ No
��Uv
If no, vrhat is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than ihat of applicant, indicate below: Is the property in question:
� ❑ Real Property ❑ Mobile Hmie QC 61.1-�
��me of mortgagee or contract seiler �
�d��e �'�.- �-�-�. • a�os- y � 8s
Address of mortgagee.or coNrad seller (number and sf�eet, city, state, ZIP •/�-�� � a�0 5''] � S
cf
Name of assignee or other owner or holder of mortgage
ot assignee (numbe� and sf�eet, city, state, ZIP code)
Ooes applicant own property in any olher I If yes, what county?
counry in Indiana?
Deduction approved in the amount of:
20 �� 20 �_ 20 Q
� � P
Signature
— DrawerNO..Q`•'�`1-�...°....
Wha � ^�"'�������� tedon
Card NO. ••
� y, � ;oNo
COUNTY AUDITOR
20
Counry Auditor
20
20
Date
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature
Full
T�C.,
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
authorized person