HomeMy WebLinkAboutMortgage_Stricklandrt�° STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
"' ' �� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�: ��w ! State Form d3709 (RS l 4-03)
Prescn�ed by Department of Loral Gdvemmeni Finance
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INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located. -� F, , � ^
Filing Dates: 7J Real Property: During the 12 months before May 11 of the year the deduction is to be effecti've� t1 �.
2) Mobile Homes assessed under IC 6-7.1 J: Between January 15 and March 2 0( t6e year the deduction•is to��efrective.
See reverse side for additional instructions and quali�cations. SEP 1- z��3
Applirant (avner or
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�3SONC'�. _
Taxing Distrid Key mb / legal description Record number O�
( p' �' r JT r�_ oo� (� � Page number � �'/ '-7
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Assessed value of real property as of .� Mortgage / Contraci indebtedness unpaid as of Is the applicant the sole legal or equitable
Maroh 1, current year - March 1, current year � ' b000 owner? ❑ Yes ❑ No
� ��0 0
a
If no, what is his / her exact share of interest?
If name on record is different than that of applicant, indicate below:
mortgagee or contract seller
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contrad seller (number and st2et, city, state;
Name of assignee or other owner or holder of mortgage
�\ddress of assignee (numberand street, city, state, ZIP code)
Does applicant own property in any olher I If yes, what county?
county in Indiana?
Deduction approved in the amount of:
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Signature
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VYhat Taxing Districi?
Is the property in question:
❑ Real Property ❑ Mobile Hwne pC 61.
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Has this deduction been requested on
property for current year? [I Yes 0 No
COUNTY AUDITOR
20 _� 20 Q� 20 �$ 20 � 20
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County Auditor Date
certify under the penalty of perjury that the above and foregoing information is true and correcl and that the applicanis was / were
ient o( Indiana and owner of the aforementioned property on March t, 20
�re owner u�nam /) Person aufhorized by duty executed Power of Attomey
y or by IC 6-1.1-12-.07
�esfdentgddress of applicant Address of authorized person
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