HomeMy WebLinkAboutMortgage_Nuckolls� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
` FOR DEDUCTION FROM ASSESSED VAIUATION �oun T n hi Year
�� w� � state Form aa7os (RS � a-07)
P2saiDeO Dy Department ollocal Govemment Finance
INS7RUCTIONS: �-y� File Mark
To be filed in person or by mail wiih the County Auditor of the county where the property is located. !/'�a`� ��"�
Filing Dates: i) Real Property: During the 12 months before May 11 of the year the deduction is to 6e e�����e�,��NTY. UA DITOR
2)�Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0! the yc�a e deduction is to be effective.
See reverse side for additional instructions and quali�cations.
Applicant (owner or confract 6uyer - see restricfions on reverse side)
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Taxing ' � Key number / legal description Record number
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Page number
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Assessed value of real property as of Mortgage / ContraG indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year owner? �Yes ❑ No
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If no, wnat is his ! her exacl 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 question:
Real Property � Mobile Home (IC Fr1.1-�
�ame ot moAgagee or contract seller .
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Address ortgagee or contract seiler (number and street, city, state, ZIP
Name of assignee or olher owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP code) _
Does applicant own property in any other If yes, what counry? What l �0� a�� A�.��-•"� � � on
co�nry in Indiana? Dra���eY lv�' � I O� 7 No
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COUNTY AUDITOR Card �� �'�`� �� �
Deducfion approved in the amount of:
20 �`� � 20 � 20 �� 20 20 20 20
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� Signature County Auditor Date
�/ We certify under the penalty of perjury that the above and foregoing information is true and corred and thal the applicants was / were
,�a resident of Indiana�and owner of the aforementioned property on March 1, 20
Signat� (o �. �s lull name) Person authorized by duly executed Power of Attomey
' or by IC 6-1.1-12-.07
- F il resident address of applicant Address of authorized person
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