HomeMy WebLinkAboutMortgage_Williams`Ort�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' 4 FOR DEDUCTION FROM ASSESSED VALUATION
S / Siate Fwm a3709 (R4 / iP-01)
PrescribeA by DepaM�eN of Local Govemment Finance
�M
INSTRUCTIONS:
Coun Township Year
File Mark
To 6e (led in person or by mail with the County Auditor o/ the county whe2 the propeRy rs located.
Filing Dates: 1) Real Property: During the 12 months be(o2 May 11 0l fhe year the deduction is to be ef/ective.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0�� � de�n-�p.tqpbe eHective.
See ieverse side /or additional instnictions and nuaGficat�r,.�.� II N
� � JL .g �J 1lJ �j�
Applicant ( er or contract yer - see st ' tions o reverse side b •
� `l-' / /!�%%�S %` / n
Taxing is rict Key number / legal description d-uur� ,r�J.�/ ti,;` '
///'�� �O GIBSON rd - -, .. �c�
// / � �// � QD�O� _�� Page number ��
�x co
Assessed value al property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant lhe sole lega or equitabie
March 1, wrrent year March 1, current year owneR ❑ Yes ❑ No
U�`�
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicani, indicate below: Is the property in queslion:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�e of moAgagee or contracl seller i�
Address of mortgagee or wntrect seller (number and st2ef, city, te, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand st�eet, ciry, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for current year? �] Yes � No
COUNTY AUDITOR
Deduction approved in the amount ot:
Zo zo 0 zo o zo �� zo �� zo �� zo 0
�t,�-e� � P P
Signature County Auditor Date
We certify under the penalty of perjury that the above and foregoing informalion is true and corred and that ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Sign ture (owners (ull name) , Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
F I resident address o applicant Address of authorized person
� o i i�.r-a,� /.��-e G a�. u�� �