HomeMy WebLinkAboutMortgage_Sissoni.;
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i i'" +� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownshi Year
'v.. N� �! State Fwm a3709 (R6l 5-061
� Resaibed by Department of Lorel Gwemment Finance
INSTRUCTIONS: F��B�a��B
To be filed in person or 6y mail with fhe County Auditor ot the county where the propeRy is located.
Frling Dates: 1) Real Property: Dunng the 12 months before June Il of the year the deduction is to be e%cti
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 oI the yeG_t/a�,dad tive.
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See reverse side for additional instrucUons and qual�cations.
Applicant (ownerorcontract
Distrid
March 1,
�f real property as of
year
If no, what is his / her exad share of
Key number / legal description Record number
O� _�. �� Pagenumber ���
Mortgage / Contrad indebtedness unpaid as of Is lhe applicant the sole legal or equilable
March 1, current year owneR ❑ Yes ❑ No
I i�
If owned with someone other than spouse, indicate wilh whom.
If name on record is difierent ihan that of applicant, indicate below:
�e of mortgagee or conVad seller ��� �
Address of mortgagee or contract seller (number and st2et, city, state,
Name ot assignee or other owner or holder of mortgage
Address of assignee (numberand s'-
O ,'�..=..:�`ls y
Dra��'er NO....
Does applipnt own property in any c � id?
county in Indiana? ... • ,
Card NO• ....:............
Deduction approved in the amounl of:
20 �`t� 20
P
Signature
0
_.,..��� r aWITOR
20 20 20
County Audilor
❑ Real
� Mobile Home
Has this tleduqion been requested on
property for curcent yeaf? � Yes ❑ No
�
20
certify under the penalty of perjury that the above and foregoing infortnation is true and conect and that lhe applicants was / were
lent of Indiana and owner of lhe aforementioned property on March 1, 20
(owners
/N
Person authorized by duly exewted Power oi Attomey
or by IC 6-1.1-12-.07
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