HomeMy WebLinkAboutMortgage_McGarrah� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
� S 1 State Fortn a37W (R5/4-03)
� •
Prescri�ed Dy Departmem of Local Govemment Finance
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor of the county where the property is located. � � N � 3 2004
Filing Dates: 1) Real Property: During the 72 months 6efore May 11 of the year the deduction is to be e/tective.
2) Mobile Homes assessed under IC 6-1.7-7: Between January 15 and March 2 0/ t e year t�he d�,eduycti7on is to//be e9ective.
See 2verse side for additional instructions and qualifrcations. ���-✓�J�! ��t c.,.yC,�
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G!SSC!; Cu^L':;TY <.U':TC': �
Applicant (owner or ntract buyer - see restrictions on e e'side)
Taxing Distrid Key number / legal descripti
P-� o�q - ��
Assessed value of real property as of MoAgage ! ContraU indebte
March 1, wrrenl year March 1, wrrent yeer �
no, what is his / her exact share of interest?
If name on record is different than
of mortgagee or contract seller
appiicant, indicate belovr.
' �13
� Re�rd
CJ
S � �Oi1 Page number
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unpaid as of Is the applicant the sole legal or equitable
owneR ❑ Yes ❑ No
/0, 0 00.
If owned with someone other than spouse, indicate with whom.
Is the property in q
❑ Real Property
_
Address of mortgagee or contract seller (number and street, city, state. ZIP - � � r'a�
' J `/� ___�,
Name of assignee or other owner or holder of moRgage ,\ 1,`GT�'�
_ P��'
Address of assignee (number and st�eet, city. �tate, ZIP code) �
>N�2��Y
Does applicant own property in any
county in indiana?
Deduction approved in the amount of:
20 O j
�
Signature _
If y�s, :vFat county?
20�� I 2o D2
�
❑ Mobile Home (IC Cr1.1
_. � r.xing District? Has this deduction been requested on
� property for current yeaR n Yes ❑ No
COUNTY AUOITOR
Zc=p� zo fl4 zo
r �
County Auditor Daf
20
/ We certify under the penalty of perjury that the zbove and foregoing information is true and corred and that the applicants was / were
i resident of Indiana and owner of the aforementioned property on March 1, 20 �
(owners (ull name)
i
Person authorized by duly executed Power of Attomey
or by IC 6-t.t-12-.07
authorized person
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