HomeMy WebLinkAboutMortgage_Johns�e� �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'�s' = FOR DEDUCTION FROM ASSESSED VALUATION ou t n ip Year
♦ N� J State Fwm 43709 (R6l 5-06)
� Presaibed by Department of Local Gwemmenl Finance J U L rj Z00�
INSTRUCTIONS: �j� ,���
To be filed in person or 6y mail with the CountyAudifo� of the county where the p�opeRy is locate[�IBSoN �QUNTY AUDITOR
Filing Dates: 1) Real Property: Du�ng the 12 months before June Il of the year the deduction is to t�e eflec rve.
� 2) Mobile Homes assessed under IC 6-i.1-7: Between January 15 and March 2 of the year the deduction is to be elfective.
See reverse side for additional instructions and qualifications.
Applicant(ownerorcontractbuyer-seeiestrictions 2verseside)
NF v-yt�
Tauing Distrid Key mber / legal description Record number
� ��0�1�-07-oZ01-�0.�?$�"d"�� Pagenumber �
Assessed value of real property as of MoAgage / Conlrad indebtedness unpaid as of Is the applicant he sole legal or equitable
March 1, curtent year March 1, current year ownef? es 0 No
�J �
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 thal of applicanl, indicate below: Is the property in queslion:
eal Property ❑ Mobile Hane QC 61.1-�
�me of moAgagee or contrad seller /� J
C' .Cit 1..
Address of mortgagee or contraG seller (number and st2et, city, state, ZI
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant awn property in any other If yes, what counly? What Taxing Distric[? Has this deduction been requested on
county in Indiana? property for curtent year? � Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �_ 20 �� 20 20 20 20 20
T �
Signature County Auditor Date
'� We certify under the penalty of peryury that the above and foregoing information is true and correct and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power of Attomey
,fi or by IC 6-1.1-12-.07
Full r ent addres of applicant Address of authorized person