HomeMy WebLinkAboutMortgage_Hurt (2)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�. w� J State Fwm a3709 (RS / 4-03)
� PrescnDed by Depenment of Loral Gtivemmenl Finance
To beR�UC�T10N rson or by mail with the CountyAuditor of the county where the property is located.� ��I'� �
Filing Dates: 1) Real PropeRy: During fhe 12 months before May 11 0/ the year the deduction is to be eflective.
2J Mobile Homes assessed under IC 6-1.1-7: 8etween January 15 and March 2 o(the year tlye�dedyyti9nZs��6e eHective.
See reverse side for additional instructions and qualifications.
Applicant (owner or contract
Assessed value of real property �s of
March 1, current year
If no, what is his / her exac[ share of interest?
name on record is different than that
of mortgagee or contraIX seller'
Key number / legal description Record number
�G-�9-ao �oo-aao.as' - y
OO�^ /�n ��� Page number
li(��
Mortgage / Contrad indebtedness unpaid as of Is lhe appli
March 1, current year owner?
indicate below:
Address of mortgagee or contract seller (number and sfreet, city,
Name of assignee or other owner or holder of mortgage
assignee (number and st2et, city, state, ZIP code)
1 the sole legal or equitable
❑ Yes ❑ No
Ii owned with someone other than spouse, indicate with whom.
❑ Real
❑ Mohile Hmie QC Fr1.1-�
Does applicant own properfy in any other I If yes, what county? What Taxing District? Has this deduclion been requested on
counfy in Indiana? � property for current yea(? � Yes ❑ No
approved in the amount of:
20 �QZ
Signature
20 �� 20
Y
COUNTY AUDITOR
� I' I�
_ County Auditor
20'
20
20
� We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full
�� �' I
address of applicant
qo3
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ofauthorized person