HomeMy WebLinkAboutMortgage_Dillon�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' f FOR DEDUCTION FROM ASSESSED VALUATION T �� Year
'•• / Sta;e Fwm a3709 (R51 a-03)
PrescnOed by Dapartmant of Locel G6vemment finance
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INSTRUCTIONS: � File�1�
To be filed in person or by mail with the County Auditor o( the county where the property is located. a���
Filing Dafes: 1J Real P�operty: Dunng the 12 months before May 11 0/ lhe year lhe deduction is to b�����OUNTY AUDITOR
2J Mobile Homes assessed under IC 6-7.1-7: Between January 75 and March 2 of the year the deduction is to be effective.
See �everse side for additional insWCtions and qua/ifications.
contract
Taxing Distrid /
/n/ �l
`�� ��
Assessed value of real property as of
March 1, current year
If no, what is his / her exacl share of interest?
on
Key nu(nber / legal description
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Record number O
Page number ,r-�
MoRgage / Contrect indebtedness unpaid as of Is the applicant the sole Iegal or e
March 7, wrrent year 51.I )�� O i owner? ❑ Yes ❑ No
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If owned with someone other than spouse, indicate with whom.
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name on record is different than that of applicant,
of mortgagee or contract
Address of mortgagee or contrad selier (number and
assignee or other owner or holder of mortgage
below:
cify, sfate, ZIP
Address of assignee (numbe� and street, city, sfate, ZIP code)
Does applicant own property in any other If yes, what county? I What Taxing Disirict?
county in Indiana?
_ _ _ _ COUNTY AUDITOR
)educti ��_
zo� DrawerNO......�.�.�.. zo �9 �c
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Signatu
Card NO . ..................... � ��/I/J�
Auditor
Is ihe property in question:
❑ Real Property ❑ Mobile Home QC G7.1-�
Has this dedudion been requested on
property for wrrent year? � Yes� No
20
Date
20
/ 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 Atlorney
or by IC 6-t.t-12-.07
authorized person