HomeMy WebLinkAboutMortgage_Chamness`PrtN STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES
-' : FOR DEDUCTION FROM ASSESSED VALUATION
S�� / Slate Form a3709 (R4 / 10-07 )
� Prescribe0 Dy Depanmenl N Loral Govemment Finance
INSTRUCTIONS:
To 6e filed in person or by mail with the County Audifor of the counly where the property is
Filing Dates: 1) Real Property: During the 12 months be%re May 11 of the year the deduction is to be effective.
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and Ma�ch 31 0( the year the deduction is to 6e eflective.
See reverse side /or additional instructions and qualifications.
Applicant (o r or contract b er- see�restncti� verse side
Taxin¢Qistrict Key number / legal descripti ecord numb _
� \j Page number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exacl share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than thai of applicant, indicate below: Is lhe property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-n
ne of moRgagee or contrad seller � ,
R
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st�eef, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for wrrent yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
zo �_�b 20 �� zo � 20 0� zo o� 20 ,�� zo
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Sig ature 0 County Auditor Date
'' We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
�sident of Indiana and owner of the aforementioned property on March 1, 20
Si a re owners ame) Person authorized by duly executed Power of Attomey
' or by IC 6-1.1-12-.07
Full resident ad ss of applicant Address of authorized person
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