HomeMy WebLinkAboutMortgage_Shawgo!a y 4 STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
°i:�; FOR DEDUCTION FROM ASSESSED VALUATION n� rn shi Year
� State Fortn 43705 (R6! 5-06) �
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� Presaibed by DeparVnent of Lonl Govemmeni Finance L�ool
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INSTRUCTIONS: � �'efh�ric
To be filed in person or by mail wrth the County Auditor of lhe county where the property is /ocafed. �16 TY A�p�TpR
Filing Dates: i) Real P�operty: Dunng the 12 months before ,lune 17 of the year the deduction is to be e�ff�c�ji�UN
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the��ar the deduction is to 6e eflective.
See reverse side fo� additional instrucfions and qualifications.
Applicant (owner or contract b�,yer - se� reshictions on reverse side) �
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Taxing DistriG Key number / legal description cord number O
� _ •! Page number
-� -0�-30 -�i, a 7 ��
Assessed vatue ot real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, current year owneft ❑ Yes ❑ No
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If no, what is his / her exact share of intere�l? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate belovr. Is lhe property in question:
Property � Mabile Home pC 61.1-�
�me of mortgagee or contract seller
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Address of mortgagee or contrad seller (numb and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sfreet, city, s(ate, ZIP code)
Does applicant own property in any olher If yes, what county? What Taxing Distrid? Has this deduqion been requested on
county in Indiana? property for current yea(?� Yes� No
COUNTY AUDITOR
Deducfion appro� ed in the amount of:
20 0� 20��'_ 20 Oi 20 20 20 20
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Signature County Audilor Date
�'/ We ceAify under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1. 20
Si atur ( ners full name) Person authorized by duty executed Power of Attomey
— . or by IC 6-1.1-12-.07
FuII resident address of applicant Address of authorized person
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