HomeMy WebLinkAboutMortgage_Dyson�
1
� ,�. �
�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form a3709 (RS / 6-03) . �
P25cribcW Oy Department of Local Govemment Finance
Coun Township Year
FI E .r
INSTRUC7/ONS: FEB �;,$�yp5
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real PropeRy: Dunng the 12 montbs be%re May 11 01 the year the deduction is to be eRe� �
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o(the year th"e de�lon� be effective.
See reverse side for additional insbuctions and quali�cations. a�BSON COUNTY AUDROR
a�o- iy-��-�03-o�.a�e -��
Applicant (ow orcontract 6uyer- see r�t�dions oryrevers�de)
Taxing
/ o
ltfQ
Assessed value of real property as
March 1, current year
Ii no, what is his / her exacl share of interest?
Key number /
�� - �a��-uo
Rewrd
number
Mortgage / Contrad indebtedness unpaid as of I Is the applicant the sole legal or
March 1, current year owner? ❑ Yes ❑ No
name on rewrd is different than that of applicant, indicate below:
�me of mortgagee or contract seller s
/Q/1!% OX 6!
Address of mortgagee or contract seller (number and street, city,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sf2et, city, state, ZIP code)
Does appliwnt uwn property in any other If yes, what county?
county in Indiana?
Dedudion approved in fhe amount of:
20
Signature
20 �
�� I
If owned with someone other than spouse, indicate with whom.
ZIP
❑ Reai
Taxing Distrf "
COUNTY AUDITOR
20 �� 20 �
� \
County Auditor
20
❑ Mobile Home (IC Cr1.1-
iescea on
Yes ❑ No
�_
Dra wer 1V0 Qes� �
Card No '
3�.
20
Date
certify under the penalty of perjury that the above and foregoing information is true and corred and that lhe applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
name)
Person authorized by duly executed Power of Attomey
or by IC 6-t.t-12-.07
� Address of authorized person
6 �����: �76 6a