HomeMy WebLinkAboutMortgage_Jenkins (3)AR,n� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�"' �' FOR DEDUCTION FROM ASSESSED VALUATION �Count[� i ToIwnshi�� Year
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� Prescribe0 by Departmenl ot Local Govemmen� Finance
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INSTRUCTIONS: Fi �FAark
To 6e filed in person or by mail with the County Auditor of the county where fhe propeRy is locate 3�u'`'`"'-�
Filing Dates: 1) Real Property: During the 12 months be7ore May 11 01 the year the deduction is�to be'eff€ct(u.PJ! �"!7Y AUDITGfl
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and March 31 of the year the deduclion is to be e/%ctive.
See reverse side (or additional instiuctions and qualifications.
Appli nt owner rcon�ct er- see tn ion on rev rse side)
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Taxing District y number / legal description Record number O/
� o/ /�" /n/��/ �� Page number Q
7 (J 7
Assessed value of real property as of MoAgage / Contract indebtedness unpaid as of Is lhe applicant the sole Iegai or equitable
MarcFi 1, current year March 1, wrrent year owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone olher than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Properiy ❑ Mobile Hane (IC 61.1-�
e of moAgagee or contraIX seller
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Address of mortgagee or contrad selier (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, ciry, state, ZIP code)
Does applicant own property in any other I( yes, what county? Whal Taxing Distrid? Has lhis deduclion been requested on
county in Indiana? property for curtent year? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � 20 �� 20 �� 20 n.r 20 20 �Z 20
.S � � P �
Sig ture Q 9 County Auditor Date
�� We certify under lhe penalty of perjury that the above and foregoing information is true and corred and thal ihe applicants was / were
�sidenl of Indiana and owner of the aforementioned property on March 1, 20
Si na r(own s full m person authorized by duty executed Power of Attomey
� or by IC 6-1.1-12-.07
Full resident address f a licant Address of authorized person
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