HomeMy WebLinkAboutMortgage_Walker (5)� rtv�
/i � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
°` „ FOR DEDUCTION FROM ASSESSED VALUATION
� w� y State Farm 43709 (R6 / 5-06) _
� Presaibed by Depariment of Loml Gwemment Finance
INSTRUCTIONS:
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File Mark
To be tiled in pe�son o� 6y mail with the County Auditor of the county whe�e the property is located. `7�Qµ �
Filing Dates: 1) Real Property: During the 12 months before ,lune I7 0/ the year the deduciion is to be eNective. �� a �'
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 of the yea� th�tffi'dOCti�t4ibeF9�idtu'1�.
See �everse side lor additional instructions and qualifications.
Appticant (owner,qr ntract buyer- see restrictions on reverse side)
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Tauing Distrid Key number / legal description Record number
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Page number
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Assessed value oi real property as of Mortgage Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, current year March 1, current year owner? �s � No
Qd
Ii no, what is his / her exad share of inlerest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicale below: Is lhe property in question:
eal Pmperty ❑ Mobile Home QC 61.1-�
me of mortgagee or conVad sel r
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and s6eet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requesled on
county in Indiana? property for curtent year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 � 20 � 20 20 20 20
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Signalure County Auditor Date
/ We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and lhat the applicanls was / were
a resident of Indiana and owner of the aforemenlioned property on MarcF� 7, 20
Signature (ow ers 11 name) Person authorized by duly exewted Power of Attomey
1 or by IC 6-1.1-12-.07
Full resident ad'r ss of applicant Address of authorized person
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