HomeMy WebLinkAboutMortgage_Held�.��STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Townshi Yea!r�
�J• SUteFortn43709 (R6/5-06) , A y
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�«• Presaibed 6y Department of Local Gwemment Finance �
INSTRUCTIONS: '�A�i e MarZko�B
To be filed in pe�son or by mail with the CountyAuditor of the county whe�e the propeRy is located. `�j
Filing Dates: 1J Real Property: Dunng the 12 months before ,lune 11 0/ the year the deduction is to be effectivcf' "`� '6
2J Mobile Homes assessed under IC 6-1.1 J: Between January 15 and March 2 0l the year��c���,�{�o`v�qp9�getive.
See reverse srde fo� additional insfnic6ons and qualificafions.
Taxing
buyer-
�
Assessed value of real property as of
March 1, wrrent year
If no, what is his / her exact
If name on record is difterent thar
mortgagee or contrad s
Address of mortgagee or conirac
Name of
Address
or omer owne
:e (numberar
Does applicant own property in a
munty in Indiana?
20 O �
Signature
resfnctions
Key number / I descriplion Record number
��-��-i8 ioi- oo�..o3a_ �S � -
_ Page number � �
MoRgage / Contrad indebtedness unpaid as of Is the appliqnt the sole legal or equitable
March 1, current year ownef? ❑ Yes ❑ No
. �
If owned with someone other than spouse, indicate with whom.
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��.Y�
��o0'1-a I(xD
�90, O60
��N �.e Se.c�c,F�
`-� . C . l,t.
approved in the amount of:
20 �
I
strid?
COUNTY AUDITOR
20 20 20
County Auditor
s the property in question:
❑ Real Property ❑ Mobile Hmie (IC 61.1-�
Has this deduction been requested on
property for curcent yeaf? � Yes ❑ No
�
Date
20
�I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicanls was / were
sident of In ' na and owner of the aforementioned property on March 1, 20
� Si ' ure (o' ers full na � /�� Person authorized by duly executed Power of Attomey
�/ or by IC 6-1.1-12-.07
( resident addr ss of a plicant . Address of authorized person
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