HomeMy WebLinkAboutMortgage_Jines�� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
'F FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�w� ✓ Sure Form <37W (R51 a-03)
� PrescnOeE �y Depanment ol Lacal Govemment Pinance
INSTRUCTIONS: File Mark
To 6e filed in person or by mail with the County Auditor of the county where the property is located.
FAing Dates: 1) Real Property: Dunng the 72 months before May 11 o(the year the deduciion is to � ��
2J Mobile Homes assessed under IC 6-1.1-7: Between January 75 and March 2 0( the r t e ductiAa.� t be ective.
See reverse side Ior additional instructions and qualifications. �
Applicant (owne� or contracl
Key numbEr / legal
APR 2
`� V J
�IQ �, O C1 �' y� � O Page number � I e M
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Assesse value of real propeAy as of Mortgage / Contraci indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, wrrent year owner? ❑ Yes ❑ No
If no, what is his / her exact share of interest?
If name on record is different than that of applicant, indicate below:
�� :ne of mortgagee or contrect seller
� O
If owned with someone other than spouse, indicate with whom.
Address ot mortgagee or contract seller (number and stieet, city, state, ZIP
Name of assignee or
Address of
owner or holder of mortgage
(num6er and street, city, sfate, ZIP code)
s the property in question:
❑ Real Property ❑ Mobile Home (IC fr1.1
Does applicant own property in any other I If yes, what county? I What Taxing District? Has this deduction been requested on
county in Indiana? property for wrrent year? � Yes ❑ No
Deduction approved in the amount oL
20
Signature
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0
COUNTY AUDITOR
20 C) �i 20 f% q
P �
County Auditor
20
20
Date
20
i
(�� ' We certify under the penalty of perjury that the above and foregoing information is true and correct and that the appiicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
ignat owner lull name) Person authorized by duly executed Power of Attorney
� I����r �� or by IC 6-1.1-12-.07
r�Sidery3ddress of applicant Address of authorized person
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