HomeMy WebLinkAboutMortgage_Baehl (3)�° STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
° ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�, � J Slate Fortn a3709 (R4/ 70-07) ��
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� PresaibeA by Deparimen� of Local Gevemment Finance
INSTRUCTIONS: �AN 1 `j ���ark
To be filed in person or by mail with the County Auditor o/ the county where the propeRy is locat d. //////
Filing Dates: 1) Real Property: During the 12 months belo2 May 11 0l the year the deduction i o be effect� � /) �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 t e�� e4ion-�sfb- e effective.
See reverse side (or additional instructions and qualificaGons. GIBSON C'OUN �'� RUDITOR �
Appli t ownerorcont�act buyer- resMctions on rev e side)
Taxing Distrid Key number / legal description Record number Q
n �I / Page number
�� �` O/3 - oo �/ � -��
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, cunent year ownef? ❑ Yes ❑ No
a
If no, what is his / her exad share of interest? f owned with someone other than spouse, indicate with whom.
If name on record is different ihan Ihat of applicant, indicate below: Is the property in queslion:
� Real Pmperty ❑ Mo6ife Home (IC 61.1-�
�me of mortgagee or conlrad seller /
�
Address of moRgagee or contred selier (number and st et, city, stafe, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing District? Has lhis deduclion been requested on �
county in Indiana? property for current yea(? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
zo O 3 zo �_ zo 20 � 20 �'� zo �.� zo �
P�gD � , � V �
Signature County Auditor Date
' i We certify under the penalty of perjury that the above and foregoing information is true and corced and thal ihe applicants was / were
�+esident of Indiana and owner of the aforemenlioned property on March 1, 20
Sign re (owners full name) Person authorized by duly execuled Power of Attomey
• � or by IC 6-1.1-12-.07
Full resident address of appliqnt Address of authorized person
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