HomeMy WebLinkAboutMortgage_BruceR�"" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'+4�°, � FOR DEDUCTION FROM ASSESSED VALUATION
t. � � Slate Fortn a3709 (R4 ! 10-01)
PrescriDed by DeDartment ol Local Govemmem Finante
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the propeRy is located. —
Filing Dates: 1) Real Property: During the 12 months before May 11 0l the year the deduction is to 6e ef/ective. F E B Q! %Q�?
2J Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and March 31 0/ the year t e deduction is to/b�e ef/ective.
See reverse side for addifional inst�uctions and qualifrcations. ��/� c���
at�-iy-3o -aoo -cx�o o9q �ol� .__�. �.�` - -
Applicant (owner o^contract 6uyer- see reshictions on ieverse side) � �
Taxing Dislrid
Assessed vatue of real property as of
March 1, current year
If no, what is his / her exact
jCe�mber / I�gal description L , Record number
� �
QQ r��QQ� ^ Q� Page number
� � �-1
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, currenl year owneR ❑ Yes ❑ No
�n `� �D
If owned with someone olher than spouse, indicate with whom.
name on record is different lhan that of applicant, indicate below:
of moRgagee or contraIX seller
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or hoider of mortgage
assignee (numberand st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county? I What Taxing District?
county in Indiana?
COUNTY AUDITOR
Deduction approved in the amount of:
20 �_ ' 20 �� 20Q� 20 � 20
�y a d ����
Sign ure County Auditor
s the property in question:
❑ Real Property ❑ Mobile Home pC 67.1-�
Has this deduction been requested on
property for current year?� Yes❑ No
20
Date
20
P P
certify under ihe penalty of peryury that the above and foregoing information is true and correct and thal the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners (ull name)
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
resident atldress o(�pplicant - �Address of authorized person