HomeMy WebLinkAboutMortgage_Rickettsrt�n STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
z FOR DEDUCTION FROM ASSESSED VALUATION n sh Year
� «� / Siata Form a3709 (R5/ a-03)
� PresaiDeObyDepartmeniotLOCalGovemmentFinance MAY 1 0 2005
INSTRUCTIONS: �'lja� �
To be /iled in person or by mail with the CountyAuditor ol the county where the property is located. B UNTY AUDITOR
Filing Dates: 1) Real Property: During the 72 months before May 17 0/ the year the deduction is to �� c�c�h��
2) Mobile Homes assessed under IC 6•1.1-7: Between January 15 and March 2 of the year the deduction is fo be effective.
See reverse side for additiona! instructions and qualifications.
Applicant (owner orcontrac b er- see r t' i o r ve side)
Taxing Distrid Key number / legal description Record number D/
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c� (J V .J V
Assessed value of real property as MoAgage / Contrect indebtedness unpaid as of Is the applicant the sole legat or equitable
March i, current year March 1, current year owner? ❑ Yes ❑ No
oZsDOD
I( no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�ame of mortgagee or contract selier � ^
5
Address of mortgagee or contract seller (number and street, city, te, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for current year? � Yes 0 No
COUNTY AUDITOR
Deduction approved in fhe amount of:
20 �i � 20 �� 20 �� 20 � 20 20 20
P P
Signature County Auditor Date
�/ We certify under the penalty of perjury ihat the above and foregoing information is irue and corred and that the applicants was / were
a res' of Indiana and owner of the atorementioRed property on March 1, 20
Signatur�(ow ers (ullname Person authorized by duly executed Power of Attorney
/ or by IC 6-1.1-12-.07
F II re � ent addre s o app ca' Address of autho�zed person
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