HomeMy WebLinkAboutMortgage_Lemonrt��" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
•� �� FOR DEDUCTION FROM ASSESSED VALUATION Coun , Township �Year
State Fortr a3709 (R5/ d-03) I� � �j p�
iM� �� ' �' �
� PrescriDed by Department of Local Govemmeni Finance �l �. �L_J
SEP i1 a 2003
INSTRUCTIONS: File Mark
To be filed in person or by mail with [he County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: Dunng fhe 72 montbs before May 11 0! the year the deduction is to be eNective,� 1�� �
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2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the�yeaythe`deductiomis to be�effective.
See reverse side for additional instructions and qualifications.
Applicant
Taxing
orcontract buyer
��I`!���GSdL�u� �i�'
Assessed value of real property as of
March 1, current year
If no, what is his / her exact share
restnctions an
Key number / �egal description
�„� 3 3a/O 3-�
number
Q /� —O� � � - � Page number �/ L//
Mortgage / Contrad indebtedness unpaid as of Is the applican tj, �e legal or equitable
Mar�jf'7� c�enJ,�ea� � owneR i� Yes ❑ No
lis Jo,1,
If name on record is diHerent Ihan that of applicant, indicate below:
�e of mortgagee or co trect seller
����
Address of mortgagee or contrad seller
If owned with someone other than spouse, indicate with whom.
and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
�\ddress of assignee (numberand sfreet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District?
county in Indiana?
� f. 5� �J� '�_ �_ g' COUNTY AUDITOR /�/`
Deduction approved in the amount
� Iii � �
....i : i
Signature
Is the p erty in question: �
eal Property ❑ Mobile Home (IC 61.1-�
Has this dedudion been requested on
property for wrrent year?�J Yes� No
20 <7 � 20 �z 20 �_ 20 � 20
,o e P
County Auditor Date
certiy under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was ! were
ient o( Indiana and owner of the aforementioned property on March 1, 20
of
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person