HomeMy WebLinkAboutMortgage_Carson�" STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
° FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
��� w� /� Siate Form a3709 (RS / a-03)
PrnscriDed Dy Depanmeni of Loral Govemment Finance �� �.
8
wsrRUCrioNS: SEP 0 7 2005 File Mark
To be filed in person or 6y mail with the County Auditor of fhe county where the property is located.
Filing Dates: i) Real Property: Dunng the 12 montbs be(ore May 11 of the year the deduUar��s to be,�ffective.
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and Marct�2 ol�he"�ear�e deduction is to be eflective.
See reverse side for additronal instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant (owneror
Distrid
Assessed value of real property as of
March 1, curtent year
Key number /
D/d=00/d'�
MoAgage / Contract indebtedness
March 1, current year
Record number ^�
(J
�O Page number C�/ n
�J (d-j
as of Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
If no, what is his ! her exact share of interest? � If owned with someone other than spouse, indicate with whom.
- 3— 9- o -CQO,\gla-bc�5
If name on rewrd is different lhan that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Horrie (IC 61.1-
,,me ot mortgagee or contracl seller
�
Address �of mortgagee or contracl seller (number and street, city, stafe,
Name of assignee or other owner or holder oi mortgage
Address of assignee (numberand street, city, stafe, ZIP code)
Does applipnt own propeAy in any
county in Indiana?
Deduction approved in the amount of:
��y��
� I 1
Signature ,
If yes, what county? � What Taxing District?
COUNTY AUDITOR
20 20 20
i
County Auditor
Has this deduction been requested on
property for current year?0 YesO No
20
Date
�
We certify under the penalty of perjury that the above and foregoing information is true and corred and thal the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person