HomeMy WebLinkAboutMortgage_Skidmore�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�� � i � FOR DEDUCTION FROM ASSESSED VALUATION
�: -�w� J State Forrt: a3709 (RS / a-03)
� PresaiEeE hy Department of Loral Govemment Finance
-� �,�,
INSTRUCTIONS: i
To 6e �led in person or by mail with !he County Auditor of the county where the property is located. ._
Filing Dates: 1) Real Property: During fhe 12 months belore May 11 0/ the year the deduction is ta�be eftecti��3
2) �Aobile Homes assessed under IC 6-1.1-7: Between January 75 and March/ 2 of the year fhe deduction is to be effective.
See reverse side for additional instructions and qualifications. (/ �
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Applicant
faxing �istria
1 OM
buyer-
Assessed value of real property as of
March 1, current year
If no, what is his / her exact share
�1 � I/
Key number / legal
Record numbeO � � � �
�!� _ �/!J�/ r � Page number
�" � co
Mortgage / ContraIX indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, currenl year �g la� i owner? �1'�s ❑ No
If owned with someone other than spouse, indicate with whom.
��-/�-a� -3r:� -�/ � � ao�
name on record is different than that o( applicant,
of mortgagee or contract seiler �/�
of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
�\ddress of assignee (numbe� and sfreet, city, state,
Does applicant own propeAy in any other If yes, what county?
county in Indiana?
Deduction approved in the amount of:
�iI-f•��t�.'f•Zi;
�,
Properly ❑ Mobile Home (IC 61.1-�
)rawer NO..Q,� �„��0�
�ard NO . .....................
What T �:quested on
❑ Yes ❑ No
COUNTY AUDITOR
20
�
County Auditor
20 � I 20
Date
20
I/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
'esident of Indiana and owner of the atoremenlioned property on March 7, 20
(owners full name)
frl����r.�/ � I : �.__
Person authorized by duly executed Power of Atlomey
or by IC 6-1.1-72-.07 '
of authorized person