HomeMy WebLinkAboutMortgage_Sams�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES�
' FOR DEDUCTION FROM ASSESSED VALUATION �
�� �. / State Fwm a3709 (RS / a-03) ' �
�«. . .
PresaiEed by Department of Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o/ the county where the property is Iocat�Q � 9p
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 of [be year the deducti is to be e�e�tibcs!04
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and Marc 2 of the yea the�cJCdut
See reverse side for additional instructions and qualifications. �_ ��
contract buyer - see
�% ,. �-
Taxing
AssBss'�d value oi real property as of
March 1, wrrent year
� I� ���' � �
on reverse
number / legal
1 J-U/UJU" 4
Mo gage / Contrect indebtedness
March 1, current year
is to be effective.
Record number �� �
Page number ✓�O
J
as of Is the applicant the sole legal or equitable
owneR �s ❑ No
7�/000
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below: Is the property in question:
�
�eal Pmperty ❑ Mobile Home QC 61.1-�
mortgagee or contract
of mortgagee or contred seller (number an�l street, city,
Name of assignee or other owner or holder of moAgage
of assignee (numbe� and sfreet, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
Deduction approved in the amount of:
20 �
�
Signature _
20 ��
ZIP
Drawer n`0.:.�.d..�.......
�at � 5 ao a
CardNO . .....................
� � li � `� . �,
COUNTY AUDIT
20 �_ 20 � 20
� \
County Auditor
20
Date
20
iested on
Yes❑ No
certify under the penalty of peryury that the above and foregoing information is true and corred and that ihe applicants was / were
ient of Indiana and owner of the aforementioned property on March 1, 20
jre n /ull name) Person authorized by duly executed Power of Attomey
� � o /I / l� /�2�� / �Ybv IC 6-1.1-12-.07
authorized person
e