HomeMy WebLinkAboutMortgage_Scott STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun :iH',Ej,m'' S
FOR DEDUCTION FROM ASSESSED VALUATION
= State i 43709(R71/609)
e Prescribed by Department of Laal Government Finance - us
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INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. mad .. 4(
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. IM .n,.' • ditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)monA.{B SO N C r NTY Al g,Q 2
before March 31 of each year the deduction is sought - county
See reverse side for additional instructions and qualifications.//.
AppGppt fill ,1 buyery-see restrictions on reverse
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vatic of real property as of Mortgage/Contract indebtedness unpaid as of I Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
March 1,one year March 1,current year date of application legal or equitable metier?
❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below.. Is
property in question:Annually Assessed
Real Property ❑Annoy Assessed
r ICI `G Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller \\\777���///
Address of mortgagee or contract seller(n and street city,sta and ZIP code)
Name of assignee or other owner or holder of mortgage
•
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other If yes,what co nty? - What Taxing District? Has this deduction been requested on property
county in Indiana? El yes ❑ No for current year?
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved In the amount of.
- - 20 20 20 20
Drawer NO �O 2 3.... County Date(month,day,year)
Card NO. S C X "E---*-- I foregoing information is true and correct and that to applicant is a resident of Indiana and
ite application is filed.
\1)I Date(month,day,year)
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Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) .