HomeMy WebLinkAboutMortgage_Glaser�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� 1 4 FOR DEDUCTION FROM ASSESSED VALUATION Cow
ti.��.M� / State Fartr, a3709 (RS / a-03)
PrescnCeC 6y Depanmeni of Local Govemment Financa
� �� 1 �
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor o/ the counfy where the property is locafed.
Filing Dates: i) Real Property: Dunng the 12 months before May 11 0/ the year the deduction is to 6e et
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and MarcA 2 of the year
See reverse side for additional instructions and qualifications. �
Applicant (or�ner
Taxing District
buyer- se� restrictions on reverse side)
Key number /
Nark .--{
J .� � �
;is to 6e etfective.
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Record number
r. 3
Page number � 3a�
Assessed value of real property as of � Mortgage Contracl indebtedness unpaid as of Is the applicant e sole Iegai or equitable
March 1, current year March 1, current year owner? s❑ No
If no, what is his / her exacl share of
If name on record is differenl lhan that of applicant, indicate below:
of mortgagee or contract seller
If owned with someone other than spouse, indicate with whom.
of moAgalgee or contraci selier (number and street, city, state, ZIP
of assignee or other owner or holder of mortgage
�
Is the property in question:
❑ Mohile Home (IC 67.1-�
oi assignee (number and street, city, state, Z�P cotle) .a. 3
Drawer NO...I.J. 3.• �`?
Does applicant own property in any other I if yes, what counry? requested on
county in Indiana? 'Q Yes� No
� Card NO . .....................
Deduclion approved in the amount of:
�
Signature
20
couNrr ,
20 �� 20 �'� 20 �
� P
County Auditor
20 �_' 20
Q
Date
/ We certify under ihe penalty of perjury ihat the above and foregoing in(ortnation is true and correct and that the applicants was / were
,esident of Indiana and owner of the aforementioned property on March 1, 20
(owners full name)
�nt address of pplican�\
'. / %ie-i 3 % % U�
Person authorized by duly executed Power of Aftomey
or by IC 6-1.1-12-.07
of authorized person