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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�+ �� / Sute Fwm a3709 (R5 / 4-03) . � . � ' � . ; . , -- ' ,
� P25aibed by Depanment of Local Govemment Finance
—�9
INSTRUCTIONS: � � ��� � ��,
To be filed in person or by mail.with the Counry Auditor of the county whe�e the property is located. 1LJ �
Filing Dates: 1) Real Property: During the 72 months before May 11 01 the year the deduction is to be eRective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the yea� �h'9�deduct�o��tlp be ef(ective. �
See reverse side for additional instructions and quali�catrons. �, i� �
(owner or
r
buyer- see� restrictions
Assessed value of real property as of
March 1, current year
no, what is his / her exact share of interest?
Key
�
e side)
/ legal descriptic n
�(>.�47 n— O c
MoAgage / ContraG indebtedness unpaid as
March 1, current ye2r _
If name on record is different lhan that of applicant, indicate below:
of moRgagee or contrect seller
Record number
Page number
Is the applipnt the sole legal or equitable
owneR ❑ Yes ❑ No
g0�
If owned with someone other than spouse, indicate with whom.
Address of morigagee or contracl seller (number and street, city, state.
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
property in question:
❑ Real Property p Mobile Home QC 61.1
Does applicant own property in any other I If yes, what counry % �nlhat Taxing Distrid? Has this deduction been requested on
county in Indiana? . � i property for current yea� n Yes� No
COUNTY AUDITOR
Deduction approved in ihe amount ot:
20 O�j I 20 L%� � 20 � 20 ��
r ,� ,9 -�
County Auditor
20�_ 20
P
Date
20
/ We certify under the penalty of perjury that the 2bove and foregoing information is true and correct and that the applicants was / were
. resident of Indiana and owner of the atorementioned property on March i, 20
(owners full
Person auihorized by duly execuled Power of Attomey
or by IC 6-1.1-12-.07
address of applicant IAddress of authorized person