HomeMy WebLinkAboutMortgage_McEllhiney�'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
:+,w� / State Fortn a3709 (RS / 4-03)
� �' PrescnbeC by Department of Loral Govemment Financa
INSTRUCTIONS:
oun _ Townshi Year
� � � �
NOV 0 3 2005
File Mark
To be filed in person or by mail with the County Auditor o/ the county where the property is located.
Filing Dates: � 1) Rea/ Property: Dunng tbe 12 months belore May 11 0/ the year the deduction is to 6e e� cfflr"e.'��y"
2) Mobile Homes assessed under IC 6-7.1-7: Between January 75 and March 2 of t�e,�ea � thejd�duct �sTto�be ef(ective.
See reverse side for addifional instructions and qualifications.
Applicant (ow r r confract buye - see re ons on reverse si ,� n�
C�itt.o.l,�, G�'� �
Taxing Distri Key number / legal description Record umber `�`
...)
QO I� � O� D� bU Page number �
Assessed value of real property as of Mortgage / Contrect indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year� March 1, current year owneft ❑ Yes ❑ No
d
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
� - D-Gb2 -0�0/- G60. �a/-GYI�.
If name on record is different than thal of applicant, indicate below: Is the property in question:
� ❑ Real Property ❑ Mobile Home QC 61.1-�
�me of mortgagee or contract seller n
J
Address of moAgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does appticant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? .� property for wrrent year?(] Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � 20 �Q� 20 �� 20 20 20 20
� P
Signature � � County Auditor Date
� �
W certify under the penalty of perjury that the above and foregoing information is true and corred and lhal the applicants was / were
a re �denl of Indiana and owner of the aforementioned property on March 1, 20
ig aWre (owners�full name) � Person authorized by duty executed Power of Atlomey
� or by IC 6-1.1-12-.07
F II re ide t addiess of applicant Address of authonzed person