HomeMy WebLinkAboutMortgage_Denny`'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
� �=��-J State Form d3709 (R514-03)
PresaiCed Cy Departmem of Local Govemmem Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the counry where the property is located.
Filing Dates: 1) Real Property: Dunng fhe 12 months be%2 May 11 0/ the year the deduction is to be e��ivq ���„C
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0! the yeai tlie d�d c � to be effective.
See reverse side for additional insfructions and qualifications. �-v,,, �,�
(owne� or
c
Assessed value of real property as of
March 1, curcent year
If no, what is his / her exact share of interest?
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on
Key number / legal description /(— Record number o �`—
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Q O� Q O �O ^� � Page number / D� 7
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Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or eq
March 1, current year � owne(? ❑ Yes ❑ No
� �
If owned with someone other than spouse, indicate with whom.
If name on record is different lhan lhat of apPlicant, indicate below:
❑ Reat
of mortgagee or contrad seiler y �
Rddress of morigagee or contracl seller (number and st
Name oi assignee or other owner or holder ot mortgage
cify,
of assignee (number and st2et, city, state, ZIP code)
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ueslion:o p, d a
I
0 Mobile Home (IC 61.7
Does applicant own property in any other If yes, what�counry? What Taxing District? Has this deduction been requested on
county in Indiana? property for wrrent year?� Yes� No
Deduction approved in the amounCot:
20 � . 20 �_ 20 _Q'
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Signature
COUNTY AUDITOR
20
County Auditor
20
20
Date
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We certify under the penalty of perjury that the above and foregoing information is true and correcl and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
� t e ow er's 11 n me) Person authorized by duly executed Power of Attomey
� .✓I,✓1,1/,1 a� by ic s-i.i-iz-.o�
of applicapU _ . �Address oi authorized person