HomeMy WebLinkAboutMortgage_Sullivan (6)w'� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� �� / StateFwm43709(R51a-03)
� Prescribed by Department of Local Govemment Finance
�'5 ���{{{ �! �'�'1 '-"�\
INSTRUCTIONS: f�.� � 'y .7—� File Ma�
To be �led in person or by mail with the County Auditor of the counry where the property is k!icated. .� ��
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ the year the deduction is to be eRective
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ th� ��r the�d��n is to be e8ective.
See reverse side for additional instructions and qualifications.
(owner con t t�r - see
Taxing
Assessed value of real property as of
March 1, current year
If no, what is his / her exact share of interest?
If name on record is diHerent than that
ot mortgagee qf�contract seller
Address of mortgagee or contract selier
Name of assignee or other owner or
?n
Key numbe�
���'-oao�l�-�
Record number
number
tg ge / Contract indebtedness unpaid as of Is the applicantlhe sole legal o� equita6le
, curtent year owner? ❑ Yes ❑ No
/OD 2�
If owned with someone other than spouse, indicate with whom.
�er and stre�t, city,
mortgage
and street, city, state, ZIP code)
Does applirant own property in any other If yes, what counry7 I What Taxing District?
county in Indiana?
�1,,�'a, �•� —
Deduction approved in the amount of:
20 �/�
Signature
20 0�
�
d p e � —
p�.F-Q»��z.
20 � � ��
P �.�-Inz K l '
Counry Auditor
the property in
❑ Real Properry ❑ Mobae Home (IC E1.
Has this deduction been requested on
property for current year? ❑ Yes ❑ No
20 (7�
P
Date
20
I! We certify under the penalty of perjury that the above and foregoing infortnation is true and corceci and that the applicants was 1 were
,�sident of Indiana and ovmer of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1•12-.07
person
$a
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