HomeMy WebLinkAboutMortgage_Woods`° R�' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-' : FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
S � State form a3709 (R4/ 10-Ot)
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Prescribea by Department of Local Govemment Finance
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INSTRUCTIONS: File Mark
To be filed in person or by mail with the CountyAuditorof the counfy whe2 the property is located.
Filing Dates: 1) Real Prope�ty: During the 12 months 6e%re May 11 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC fr1.1-7: Befween January 15 and March 3�'j'�ea�d�i is be eHective.
See reverse side lor additional instructions and quafifications. 1
(owner or contract
W
Taxing Dislrid
•� .i
Assessed value ofrealproperty
March 1, current year
Key
on reve se side)
� �-/ �
iumb legal descriplion
G�BSON COU�lTY
o / -��� � _ � Page number n � - �/
WC
of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneR � Yes ❑ No
I -1 � S 06 �
If 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 applicanl, indicate below:
N,ame of mortgagee or contract seller �� �-
Address of mortgagee or contraIX seller (number and street, city, s
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?
counry in Indiana?
Deduction approved in the amounl of:
Taxing District?
COUNTY AUDITOR
20��%� 20Q� I 2��� 20�
- •i�
O,n _r� . ._�....e_� T �
County Auditor
20 �
Is the property
❑ Real Proper
❑ Mobile Horrie (IC 61.
Has this dedudion been requested on
propeAy for cunent year?� Yes❑ No
20 QZ 20 �� 0
P P
Date
I/ We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and lhal lhe applicants was / were
,esident of Indiana and owner of the aforementioned property on March 1, 20
(owners (ull name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
resident address of applipnt �Address of authorized person