HomeMy WebLinkAboutMortgage_Nelson (3)e`° �° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
+"°,.. ;: FOR DEDUCTION FROM ASSESSED VALUATION t+.Coun' Ea �ownsFiip 1 Year
S J Siate Fortn 43709 (R4 / 76-01) � � �� �
�w '
� Prescribed by Department of Loral Govemment Fvunce
INSTRUCTIONS: � � File�Mark
To be filed in person or by mail with the County Auditor o/ fhe county where the property is located:.�,�-,i�,�-� �
Filing Dafes: 1) Real Property: Dudng the 12 months be%re May 11 of the year the deduction is to tieieflective�l'K?'� AUDITGF.
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and March 31 of the year the deduction is to be eflective.
See reverse side 1or additional instructions and qualifications.
Applicant (own r or contract buyer- see iestrictlon n reverse side)
�
Tauing Disirid / e umber / legal descriplion Record number � r� 7� ,G�
� Q- G� 3 3 a-� Page number
7
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is lhe applicant the sote legal or equitable
March 1, current year March 1, wrrent year owne(? ❑ Yes ❑ No
d
If no, whal is his / her exact share of interest? / If owned with someone other than spouse, indicate with whom.
If name on record is dif(erent than that of applicant, indicate below: Is lhe property in question:
❑ Real Properly ❑ Mobile Home pC 61.7-�
�eme of mortgagee or conlrad seller '/
D IV �
Address of moRgagee or contract seller (number and street, city, state, ZIP
� - -1
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any olher If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for curtent yeaf? 0 Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
zo f1,� Zo �[_ zo 0 zo � zo O'' zo �_ zo �
� '� � P P
Signature County Auditor Date
�/ We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that ihe applicants was ! were
resident of Indiana and owner of the aforementioned property on March 1, 20
i alure wners (ull na e) Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
ul esident ress of a i t � Address of authorized person
i