HomeMy WebLinkAboutMortgage_Lake��� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
4 FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
,. w i SWteFOrmd3709(R5/4-03)
� PrescnDed by Depanmeni ot local G6vemment Finance �
INSTRUCTIONS: � ��le� �
To be filed in person or by mail with the County Auditor o! the county whe�e the property is located.
Filing Dates: 1) Real Property: During the 72 months belore May 11 0l the year the deduction is to fle
2) Mo6ile Homes assessed under IC 6-t 1-7: Between January 15 and March 2 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications. MAY 1 � Z��S
Applicant
Taxing
Assessed vatue of real
March 1, wrrent year
I( no, what is his / her exact share of interesl?
If name on record is different than thai
of mortgagee or wntra-�-seller
Address o( mortgagee or �
Name of assignee or �
Address of assignee (n,..
on reverse side)
Key number / legal description
� ��—d/OS
Mortgage / Contract indebtedne
March 1, wrrent year
.J
below:
GIBSON COUNTY AUDITOR
Record number O �
Page number 2 � U �
)
Is the applicant the sole legal or
owner? ❑ Yes ❑ No
unpaid as of
� � I
If owned with someone other than spouse, indicate with whom.
5/ 3
� '•• and st�eet, city, slate, ZIP
ra�e
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C'araN� ,�����J
Does applicant own property in any oth�. ••� ,c Taxing District?
county in Indiana? (
Deducfion approved in the amounf
20 L�J6
Signature
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COUN � . AUDITOR
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P e
County Auditor
Is the property in questian:
❑ Real Property ❑ Mobile Home (IC 6-7.1
Has this dedudion been requesled on
property for current year?� Yes� No
zo
Date
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' We certify under the penalty of perjury that lhe above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
�natYre (owners full na e Q Person authorized by duty executed Power of Attorney
�� A � i r , r V G �P �� 11�\ e i 1 or by IC 6-1.1-12-.07
Full resident address of applicant Address of aufhorized person
� a15 7tuSSle.r � I�ind Ct�u r