HomeMy WebLinkAboutMortgage_Lange (3)� �.n
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
e� "' .' FOR DEDUCTION FROM ASSESSED VALUATION Count Township Ye:
S � � � State Form a37o9 (Ra � 10.01) .� � � �' �' . • . —
� PrescribeA by Depanment ol Loral Govemment Financa
INSTRUCTIONS: • '
To be filed in person or by mail with the County Audifor ol the coun � F3ile�Mark-. �
ty where the piaperty is locate� �� , t�� r� l�
Filing Dates: 1J Real Property: Dunng the 12 months 6e%re May 11 of the yea�lhe deduction'is to �be eNectroe. � �� '
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January� 15'and Maich 31: of'the year the deduction s t be eHective
See ieverse side for addifional insWctions and qualifica6ons. MAR l. � Z��� . ' .
Applicant
7? I �
o� contrac( 6uyer- see
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�r c v� ce-�a p�
Assessed value ofrealproperty as of
March 1, curtent year
�
If no, what is his / her exact share of interest?
on reverse side)
�
Key number / legal,d'e�cription
� •
� � � -�02`�ag r U �
Mortgage / ContraG indebtedness unpaid
Ma ch 1, curtent year . �
'�6 9� 9��
If name on record is different ihan that of applicanl,
of mortgagee or contrad seller
Address of mortg�e
Name of assign�
Address of assiqnee
or contrad seller
.�(--_�
ther owner or ho6
below:
�
er. , ,
,�� � �-�c�-
Page
�
as of Is lhe applicant the sole legal or
ownef? �es.:OtNo
If owned with someone other than spouse, indicate with whom.
�..�. 07- 3�,�a .
imber and st2et, city, state, ZIP
��a� ��;ll��
of mortgage
����,�,..�, o��� aucei, cuy, sia�e, c�r coaB)
Does applicant own property in any ofi
county in Indiana?
Deduction approved in the amount of:
20 � 20 ��r
�
Signalure
If yes, what county? What Taxing Distrid? �'
COUNTY AUDITOR
20�1 (� 20 O /
� P
County Auditor
� �l.
i�
erry in quesuon:
�perty �❑ Mobile Horne QC 61.5
. . � ... . . � e
.� n�Y'
Has lhis deduction been iequested�or
property for current year? ❑ Yes ❑ N
20 �`L
�
Date
20
I We certify under the penalty of perjury that the above and foregoing infortnation is true and correcl and that the applicants was / were
I ent of Indiana and owner of the aforementioned property on March 1, 20
gn ure ers full name) Person authorized by duiy executed Power of Attorney
� � ` or by IC 6-1.1-12-.07 �
I rneiiinnl oiiA. �e ..f......c....�� . . �
il C
70
oi aumonzea person