HomeMy WebLinkAboutMortgage_Mitchell�e�"� a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'' = FOR DEDUCTION FROM ASSESSED VALUATION u hi Year
S�, . y State Fwm a3709 (R6 / 5-06) �
i«.
� ' Presvi6ed by Deperiment of Lotal Gavemment Finance
6 2�0/
INSTRUCTIONS: �-y,, File Maric
To be (iled in pe�son o� by mail with the County Auditor of the county where the p�operty is located. p�!a� ,Q�
Filing Dates: 1) Real Property: During the 12 months befoie ,lune 11 of fhe year the deduction is ��gUe�e�ti(r�.
2J Mobile Homes assessed under IC 6-i. f-7: Between January 15 and March 2 o/the yea� t���t�N@kilO(pe efiective.
See reverse side lo� additional instructions and qualifications.
Applicant (owner or contract buyer- see Festrictions on reverse side)
Taxing Distrid � Key number / legal description Record number �� /1
7
�p.•�-C.6-�,.�% 2�O -�j -/Q_ /Oa -00�, s(o �- � O� Page number ( �.� 5 7
_�
Assessed value of real pr rty as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year ownef? ❑ Yes ❑ No
�-a�� a o, YY 8
Ii no, whal is his / her exad s are of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different Ihan ihat of applicant, indicate below: Is the property in question:
❑ Reai Property ❑ Mobile Hortie (IC 61.1-�
me of mortgagee or contract seller ,( p � ...
U—L-O`- � - - t
Address of moRgagee or contrad seller (number and street, cily, state, ZIP ,�
ac�� ...... '4
Name of assignee or other owner or holder of mortgage D 1"�!`� ��� ������ y 55Y i
Address of assignee (number and street, city, state, ZIP code) �� � �' """ ������ 00
� �ao�y`IS. — .
Does applicant own property in any other If yes, what county? What Taxing Di: `� �nas this deduction been requested on
county in Indiana? property for current yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20�� 20 09 20 20 20 20 20
Q P
Signature County Auditor Date
We certify under the penalty of perjury thai the above and foregoing information is true and corred and ihat the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) � Person authorized by duty executed Power of Atlomey
- or by IC 6-1.1-12-.07
Full resideni address of applicant Address of authorized person
� 1- 2 S'. Zt/��G