HomeMy WebLinkAboutMortgage_Miller (9)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
♦ State Form a3709 (R5/4-03) '
� � Presaibed Ey Depertment of Local Gtivamment Financa
INSTRUCTIONS: File Mark
To be filed in person or by mail with the CountyAuditor of the county where the property is Iocated.IAN 1 2 Z��6
Filing Dates: 1) Real Property: During the 12 months belore May 11 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of th ear the deduction is fo be effective.
See reverse side lor additional instructions and qualifications. ��'6�
��" I.=J � i 7'f — IW �w ��� (��p GIBSON COUNTY AUDITOR
or contract buver - see
Taxing Disirid
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Assessed value oi real property as of
March 1, curtent year
no, what is his / her exad share of interest?
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Key number /
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MoRgage / Contrad i�
March 1, cunent year
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If name on record is different Ihan that of applicant, indicate below:
,me of moAgagee or contrad seller
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Address of mortgagee or cont�act seller (number � st�eet, city, s
of assignee or other owner or holder of mortgage
Record
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Page number �a '/
O y�
as of Is the applicant the sole legal or equitable
ownef? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
ZIP —
s the property 1n question:
❑ Real Property ❑ Mobile Home pC 61.
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Address of assignee (numbe� and st2et, city, state, ZIP code)
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Does applicant own property in any other If yes, what counry? VYhat'_ �_��_ �� �
county in Indiana? J proy�„
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COUNTY AUDITOR
Deduc[ion approved in the amount of:
20 � 20 � 20
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Signature
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County Auditor
20
20
Date
20
ed on
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certify under the penalty of perjury lhat the above and toregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
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oa�/�yC Oal�lGKc�"�.;
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07 .
Address of authorized person
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