HomeMy WebLinkAboutMortgage_Frederick (3)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Townshi Year
S �/ Stata Fortn d3709 (RS / 4-03)
� PresaiDetl py Department of Lotal Govemment Financa
To 6eR� ed inOpe�son or by mail wdh the County Auditor oJ the county where the property is loca et d. �� ��� Mark
Filing Dates: 1J Real Property• During the 12 months be%re May 11 0l the year the deduction is to 6e r�ff� c�tiv�.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yea�UN'e d�d�c��S to be effective.
See reverse side /or additional insfructions and quali�cations.
�a� � �
(owner or cront�act buyer - see restrictions on reverse side)
Tauing
Assessed value of real property as
March 1, current year
no, what is his / her exac[ share of interest?
If name on rewrd is different ihan that of
or contrect
Ke"y number / legal description Record number
a1G /S�/P-ob/-0o%�-�?-a�o?
Page number
� �`=- o t �a:a = oo � � L
MoRgage / Contrad indebtedness unpaid as of Is the applicant he sole legal or equitable
March 1, current year owneR �es ❑ No
I
indicate below:
�a� �
If owned with someone other lhan spouse, indicate with whom.
Address of moAgagee of�conlrad seller (number and st�eet city, state, ZlP
L1
Name of assignee or olher owner or holder of mortgage
Address of assignee (numberand street, city, sfate, ZlPcode)
Dces applipnt own property in any olher I If yes, what counry? What Taxing
county in Indiana?
Deduction
20 O.!
P
Signature
COUNTY AUDITOR
in the amount of:
20 20 �g_ 20 20
e �
County Auditor
Is the property in question:
�eal Property ❑ Mobile Home QC 61.1-�
Dra�ver \0....�V�n..�r......
C:lt"d ��. .....�.v�.l......
� 41,(�5f °o
�
Date
20
lon
�No
certify under the penalty of perjury that Ihe above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
(owners full
, .�l.
(D LP
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person