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a. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou•�■M:I�"'lu �uIi�I?i'�
air /,.. FOR DEDUCTION FROM ASSESSED VALUATION `. "�
Prescribed by Department of Local Government Finance � �
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le fa
INSTRUCTIONS:
orm find
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. i
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought I . • a.� itt Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Me during the twelve(12)m6'aL6SO N CO" TY A QITTO� r R
before March 31 of each year the deduction is sought c:o ty rt
See reverse side
e for additional instructions a a�nnd quu/ealli€ficaa/ttiiioonns. ///'
Applicant( ( M /�, b/lyerCr-see /ion. earl:tendds) et I,�(r/d �J��'y'/ /
Ta>uAlA .f�7 e%/� !//t[�-/02- / ' . c'- cw. i' oaT /N/ Page
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
March 1,anew year Mardi 1,anent year date of apparatr6)o 9/�- I°0 legal ❑ table❑owner?
/// 7 Yes No
If no,what Is his/her exact share of interest? If owned with someone other than spouse,i heater with whom
If name on record is different than that of applicant.Indicate below. Is property in question:Annually Assessed
eal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
/.p//'�' n
Address of mortgagee or contract seller v�nd sheet,city state.and ZIP coddee.)
Name of assignee or other owner or holder of mortgage I / r7 n
Address of assignee(number and street.ray,state,and ZIP code) �O�/� �� ° /v'1C/�f/Ly- /V/r
Does applicant own property in any other If yes,what county? • What Taring District? Has this deduction been requested on property
minty in Indiana? ❑ Yes ❑ No for current year? ❑ Yes I ❑ No
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COUNTY AUDITOR
Deduction approved in the amount of
20_ 20 20 20 - 20_ 20
CO Uiy S i3c 'ci -_
Signature of County Auditor
Iu-(910
I/We certify under the penalty of perjury that the above and foregoing ink f Indiana and
owner/contract buyer of the afocem-ntioned property on date application
Signature • - .name
!. . / i ,e4
7\
Ful went-•dress of appf.: t umber and'"L city,state,and ZIP code) ■
(authorized by dtdy executed Power of Anomey or by IC 6-1.1-12-0.7 1 Data(month,day,year)
Address of authorized person (number and street,city state,and ZIP code)