HomeMy WebLinkAboutMortgage_McGowen� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' � FOR DEDUCTION FROM ASSESSED VALUATION oun Township Year
��StateForm43709��R514-03) �
�«
� �• Prestn�etl �y Departrtieni ot Local Govemmenl Finance
INSTRUCTIONS: File Mark
To be fi/ed in person or 6y mail with the County Auditor of the county where the propeRy is located. -�- .. .
~ 4
Filing bater. 9) Real Property: Dunng the 72 months 6e%re May 11 of [be year the deduciion is to be eltective. �� � pg �
2) Mo6ile Homes assessed under IC 6-1.1 J: Between January 15 and March 2 01 the year tbe deduott�n is�to tia PNe
See reverse side lor additional instructions and qualifications.
.iUL 1 3 2005
(owner or
restrictions en
�9 "%?�
i a ng u t la `� Key number / IL�gal description Rewrd numbe� � �- ����� ��
/` I C 0 � O Page number �^�
`�� l 0 J
Assessed val of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, current year March 1 current year owner? ❑ Yes ❑ No
VOvO
It no, what is his /-her exact share of interest7 � If owned wiih someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
.me of mortgagee or contract seiler �/"'�
Address of mortgagee or contract seller (number and street, city,± tate `
Name of assignee or other ow
Address of assignee
or holder o( mortgage
�d street, city, state, ZIP code)
Does applicant own propeAy in any olher I If yes, what county? What Taxing District?
wunty in Indiana?
Deduction approved in Jhe amount of:
�i7
Signature
.+��
��
COUNTY AUDITOR
20 0 9 20 20
P
County Auditor
❑ Real PropeAy ❑ Mobile Home (IC Cr1.1-�
Has this dedudion been requested on
property for current year? � Yes ❑ No
20
Date
20
I We certify under lhe penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned propeRy on March 1, 20
�nature (owners ful{\t��ame) t'�, /�/�.,�, Person authorized by duly executed Power of Attorney
� Xivr. I. _T ..� 7 N n U/4�lt�Q� % or by IC 6-1.1-12-.07
ient address of applicant ,
0 � �4.e�" s� $� !l,v+�.ea
ofauthorized person
��