HomeMy WebLinkAboutMortgage_Smerchek� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
`� FOR DEDUCTION FROM ASSESSED VALUATION
��w� J Stata Form d3709 (RS / 4-03)
Prascnbetl by Depanment of Local Govemment Finance
�
INSTRUCTIONS:
To be filed in person or 6y mail with the CountyAUditor of the county where the property is located. A�� 2 3 Z��6
Filing Dates: 1) Real Property: During the 12 months be(ore May 11 0/ the year the deduction is to be efFective.
2) Mobile Homes assessed under fC 6-7.1-7: Between January 15 and March 2 0/ the year the deduction is to be effective.
See reverse side tor additional instructions and qualifications. �f�� ,G���,
GIBSON COUNTY AUDITOR
or
Taxing District
1���-�.J ��
Assessed value of real property as
March 1, current year
no, what is his / her exaci share
If name on
see re�tncnons on reverse
Key numq�r/ legal description Record number
�G /'S`-GYo o?M- `,t�7- EI� ��o
�� _ � Page number ,��aa -
MoRgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year , owner? ❑ Yes ❑ No
than that oi applicant,
mortgagee or contract seller
Address of mortgagee or contrad seller (dumber and
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP
If owned with someone other than spouse, indicate with whom.
below: a �
.� � . N �• :�-,.
Drawer NO.. i7 • • •• �
��� `� —
Caid 1�� . .....................
city, state, ZIP
Does applicant own property in any olher I If yes, what county? What Taxing Distrid?
county in Indiana?
Deduction approved in the amount oL
f'I�1�1�iI;
�
Signature
COUNTY AUDITOR
� I 20 �_ I 20 20
P Q
County Auditor
Has this dedudion been requested on
property for current yea(? 0 Yes ❑ No
20 I 20
Date
We certify under the penalty of perjury that the above and foregoing information is true and correq and lhat the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
� ,�atyre (ow� s/ul�iame) Q � Person authorized by duly executed Power of Atlomey
���j e or by IC 6-1.1-12-.07
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ea
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of authorized person