HomeMy WebLinkAboutMortgage_Sherman (4)FORM 5
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
t .� � Sffie Fortn 43709 (R3 / 10-00) Q
� Presaibe0 by State Boartl o1 Ta�c Cortmissioners
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instructio� for fiiing:
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 72 months before May 11 of the year the dedudion is to be eftedive..See
reverse side for additional insWdions and qualfiptions.
(owne�
1
Assessed value of real property as of
March 1, wrrent year .
no, what is his / her exact ;
Key �umber / legal descriF
� � O
Mortgage / Contract indebl
March 1, current year
If name on record is different than that of applicant, indicate below:
h� of mortqaqee or contrad selier �
Address of mortgagee ar conVact seller (number and
of assignee or other owner or holder of mortgage
city,
dty, state, ZIP code)
Does applipnt own real property in any If yes, what county?
other county in Indiana?
Dedudion approved in the amount of:
F�il'S'►�i3�7
S
O �
�npaid as
SEP 2 0 2001
Is the appliqnt ihe sole legal or
owneR ❑ Yes ❑ No
)��� �
If owned wilh someone other than spouse, indicate with whom.
ZIP
What Tauing Distrid? Has this dedudion been requested on
property for current yeaR � Yes� No
COUNTY AUDITOR
20 0 �� 20 0'�
� �
County Auditor
20
20
Date
20
I! e certify under ihe penalty of perjury that the above and foregoing informalion is true and correct and that the applicants was / were
ident of Indiana and owner of ihe aforemenlioned property on March 1, 20
� gnature (owners /ull name) Person authorized by duly executed Power of Ariomey
/J� or by IC 61.1-12-.07
1
!ull i nt addre of applican _ , Address of author¢ed person
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