HomeMy WebLinkAboutMortgage_Truitt��� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESG
`' f FOR DEDUCTION FROM ASSESSED VALUATION
�• ✓ Stata Form a3709 (R5/ a-03)
� �«.
PrescnDed by Department ot Local G6vemmant Finance
INSTRUCTIONS:
To be /iled in person or by mail with the County Auditor ol the county where the property is Iocatec�,4Y 0 4 Z��S
Filing Dates: 7J Real PropeRy: Dunng the 12 months before May 11 0l the year the deduciion is to 6e eXechve.
2) Mobile Homes assessed undei IC 6-1.1-7: Between January 15 and March 2 0( U�r year fh�, �du"ction is to be eftecfive.
See �everse side !or additional instructions and qualifrcations. ���� �+ �
n GIBSON COUNTY UDITOR
on
number / legal
Assessed value of �a property as of MoAgage I Contract ir
March 1, wrrent year March 1, wrrent year
I( no, what is his / her exact share of interest?
If name on record is different than that of applicant, indicale below:
of mortgagee or contract seller
Address ot mortgagee or contract seller
Name oi assignee or other owner or holder of mortgage
Address of assignee
Does applicant own property in any
county in Indiana?
slreel, city. sfate, ZIP code)
Deduction approved in the amount of:
20
SignaWre
20 �2
Record number
Page number
�
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• ♦
unpaid as of Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
If owned with someone other lhan spouse, indicate with whom.
state, ZIP
what county? � What Taxing District?
COUNTY AUDITOR
20 �_ 20 �_ 20
P $
County Auditor
Is
❑ Real Property ❑ Mobile Hane (IC 6-1.1-�
Has this deduction been requested on
property for current year?0 Yes❑ No
20
Date
�
' We certify under the penalty of perjury ihat the above and foregoing intormation is true and correct and thal the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
�nature ( s lull name) � Person authorized by duly executed Power of Attorney
% .,�.�.,. � .� ,..T.C� o� by ic s-,.,-,2-.0�
person