HomeMy WebLinkAboutMortgage_Williams (7)�
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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR OEDUCTION FROM ASSESSED VALUATION
State Form a3709 (RS / 4-03)
PrescriGed by Department of Local Gtivemment Finance
INSTRUCTIONS:
To be filed in person or by mail wifh the County Auditor of tAe county where the property is /ocated. �"jQY 1% 20�4
Filing Dates: 1J Real Property: During fhe 12 months be%re May 11 of the year the deduction is to be eBective.
2) Mobile Homes assessed under IC 6-1.1-7: 8etween January 15 and March 2 o Ihe year the deduction is �to/ be/ �effective.
See reverse side for addifional instructions and qualifications. �"�'���^�!� 1�—� .., GC. !/
GIBSO7d C:O11bTV q�pITOR
(owner or contract buyer - see restrictions on reverse side)
. . .nn , n n� n � �-.
Taxing Disirid
Assessed value of real property as of
March 1, current year
If no, what is his / her exad share of interest?
If name o� record is diHerent than that of
of moAgagee or contraIX seller
/ legal description
p6l^bi
Mortgage / Contrect ir
March 1, currenl year
below:
Record number
� Page number � a� �
unpaid as of Is the applicant the sole legal or equitable
ownef? �Yes ❑ No
If owned with someone other lhan spouse, indicate with whom.
of mortgagee or conlrad seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of moRgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? N
wunty in Indiana?
Deduction approved in the amount of:
20
Signature
20
- o�o /(� -o��d - G6/. `o'/o� -GO/
Is the property in question:
❑ Mobile Hane (IC 61.
DrawerNO.��, �� !�
.... -equested on
' � Yes ❑ No
Card \'O. .� ....................
couNrr ai
20 � 20 �p_ 20
f
County Auditar
20
Date
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' We certiry under the penalty of perjury that the above and foregoing information is true and corred and thal ihe applirants was / were
resideni of Indiana and owner of the aforementioned property on March 7, 20
name)
Person authorized by duly executed Power of Attomey
j� or by IC 6-1.1-12-.07
of authorized person