HomeMy WebLinkAboutMortgage_Meier (3)QA�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
"- -_ ' FOR DEDUCTION FROM ASSESSED VALUATION _ Count 7ownship Year
�`� w ,
S � Slate Fortn 43709 (R4 / 16-01) ���
��� Presnibe0 by Depannrent of Local Govemmeni Finance �
h E B� 1. 2003
INSTRUCTIONS: /� File Mark
To 6e filed in person or by mail with the County Auditor of the county whe2 fhe property is locatedr
Filing Dates: 1) Real Property: During the 12 months be%�e May 71 of the year the deduction is:�be.eftec`tive � �(1��1 ,n'
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0l thel�¢�;therd_ednction�islO�e ef/ective.
See reverse side for additronal instructions and qualifica6ons.
Applicant (ownerorcontiact buyer- see restrictions on reverse side)
Taxing Distrid Key umber / legal description Record number ��
� ' O `� ^ Page number � �j
ip
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March i, current year March 1, current year owne(? [/�es ❑ No
� O �� l
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 that of applicant, indicate below: Is the property in queslion:
eal Property ❑ Mobile Home (IC 61.1-�
me of mortgagee or contracl seller
,
Address of mortga ee or contrad selier (number and st2et, city, state, ZIP ,/� • �
oK` ��.
Name of assignee or other owner or holder of mortgage O 3'
'�i
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for curtent year? � Yes � No
� �-- COUNTY AUDITOR
Dedudion approved in the amount of:
2o Q� zo � zo b� zo � zo QZ zo �$_ Zo o a
�e � � �° P .P
Signature County Auditor Date
/ We certify under the penalty of perjury that the above and foregoing informalion is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signa re (ow ers 1 nam Person authorized by duly execuled Power of Attomey
��� or by IC 6-1.1-12-.07
Fu resident ad ss of applica Address of aulhorized person
a � � ti. c� sr iti �