HomeMy WebLinkAboutMortgage_Fulling�� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
E FOR DEDUCTION FROM ASSESSED VALUATION ou ns ip vear
�• � � / State Form a3709 (R5/ a-03)
� Prescn�etl �y Department ol Local Govemment Finance MAY P 2 2005
INSTRUCTIONS: �J� ,���
To be filed rn person or by mail with the CountyAuditor of the county where the property is Iocate�I.�BSO C0 NTY qUDITOR
Filing Oates: 1) Real Property. Dunng the 12 months be%re May 11 0l the year the deduction is to be e�ec[roc�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o)the year the deduction is to be effective.
�• See reverse side for addifional instructions and qualifications.
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Appliwnt ( e� r con ct 6uyer- e stnch ns o ve e side) ,
,� �� -�� ��%, ��, �D, .� �
Taxing
l.�°'� (N �
Assessed value o( real property as of
March 1, wrrent year
I( no, what is his / her exacl share of interest?
If name on record is different than that
morigagee or contract seller
Address o( mortgagee or contred seller
Name o( assignee or other owner or
Key number / legal
(/�� -�
Mortgage / Contract ii
March 1, current year
//�.
Record number
Page number
unpaid as o( Is the applicant the sole legal or
'� owner? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
rt, indicate below:
,
and street, city, state, ZIP
mortgage
Is the
❑ Real Property ❑ Mobile Home (IC 61.1-�
Dra�ver N�•............
Address o( assignee (numberand street, city, state, ZIP code) �D"�; •/ �
CardN�• ..........• o
Does appficant own property in any other If yes, what county? What Taxing Disiri� O�� _..��
county in Indiana? , rear'?LI Yes� No
COUNTY AUDITOR
Deduction approved
�
Signature
amounf
20 �
20 �`� 20 �`L 20
P P
County Auditor
Zi7
Date
20
We certify under the penalty of perjury that ihe above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20 �
3nature (owners,tull n me) Person authorized by duly executed Power o( Attorney
`I� � , �� `�� or by IC 6-1.1-12-.07
II resident address o( applicant � �, Address of auihorized person
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