HomeMy WebLinkAboutMortgage_Holmes (3)� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS '' �" T �•—`` �
� FOR DEDUCTION FROM ASSESSED VALUATION E:`Cou'n i; iTownsfiip ,� Year
f S J State Fortn 43709 (R514-03) ' � '1 � A 1�1 !�
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� P2scnbed by Department of local Govemmenl Finance SL r '.� 2004
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INSTRUCTIONS: rFile Ma
To be filed in erson or b mail with the Count Audifor o/ the count where the ro eK is located: ,/lJ�_
P Y Y Y P P Y 13SON CpUt:. V.4UGiT03
Filing Dates: 1) Real Property: During the 12 months 6efore May 11 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Applicant (owner or contract buyer- 2strictions on reverse side)
Taxing�Bi,strid Key number / legal description Record number D�
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� �v � � � ' ^ S� � Page number
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cunent year March 1 current year owneR ❑ Yes ❑ No
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If no, what is his / her exact 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 ❑ Moale Home QC 61.1-�
�me of mortgagee or contract seller
Address of moRgagee or wntrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other if yes, what county? What Taxing Distrid? Has lhis deduction been requested on
county in Indiana? property for current year?Q Yes❑ No
COUNTY AUDITOR
Deduction approved in the amouni of:
20 20 � � 20 � 20 �q_ 20 20 20
1 I
Signature County Auditor Date
�/ We certify under the penalty of perjury lhat ihe above and foregoing iniormation is true and correct and that the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
, Signature (own ts full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
F r�dent address of applicant � n Address oT authorized person
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