HomeMy WebLinkAboutMortgage_Kinklee�� t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i�-' _ E FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
S�� S�ate Form 4s7os (Ra i to-ot)
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Prescribe0 by DepartneN of Local Govemment Finance p
INSTRUCTIONS: NOV � "F����
To be filed in person or by mail with the County Auditor o/ the county where the property is located.
Filing Dates: 1J Real Property: During the 12 months beloie May 11 o7the yea� the deduction is to•be eNectiv . 'n/
2) Mobile Homes assessed under IC 6-1.7-7: Behveen January 75 and March 31 of the year-t�deduotinn_is�to�be�' eHective.
�`7.U.i.�./ni 111; �.-
See reverse srde for additional instructions and qualifications. /D G�gSO;J COU`� ��' .�UDI70R �
Applicant
Tauing Disti
�I
see
-bl����
on reverse side)
Key number / legal description
����
Record number
Page number
Assessed value of real property as of MoRgage / Contraci indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owne(? ❑ Yes ❑ No
S�/✓�
If no, whaf is his / her exacl share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than lhat of applicant, indicate below: Is the property in question:
of mortgagee or contred seiler
Address of mortgagee or contraIX seller (number and street,
Name of assignee or other owner or holder of morigage
Address of assignee (numberand street, city, sfate, ZIP code)
Does applicant own property in any other If yes, what counry?
county in Indiana?
Deduction approved in the amount of:
20
Signature
❑ Real Property ❑ Mobile Home (IC &t_
state, ZIP
What Taxing Distrid? Has this deduction been requested on
property for current year? �] Yes � No
COUNTY AUDITOR
r � ,Sr� � . �i
Count I Auditor
20 � I 20 �� 20 O`
P p P
We certify under the penalty of perjury that the above and foregoing information is true and correct and that ihe applicants was / were
resident of Indiana and owner of the aforery�gntioned property on March 1, 20
Person authurized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of�pplicant � ,� w �Address of authorized person