HomeMy WebLinkAboutMortgage_Weber (2)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
�FOR DEDUCTION FROM ASSESSED VALUATION
Siate Fwrr. a3709 (RS / a�3)
� Prescn�ed �y Department of Local Govemmeni Finance
INSTRUCTIONS: �
To be /iled in person or by mail with the County Auditor o( the county where the property is locareo.
Filing Dates: 1J Real Property: During the 12 months 6e/ore May 11 0/ tAe year the deduction is to 6e eBe�iti�e.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduca n��� be eNective.
See reverse side for additional irr�tructions and qualifications. �a� �
� �/
GIBSON Cniu�r� ..._-
contract�uyer- s�e 2stnctions on reverse side)
Taxing Disirid `
�CC� G�2ta�
Assessed value of real property as of
March 1, wrtent year
no, what is his / her exact share of interest?
Key number / legal description Record number ^�
'lJ
O/�_ /"���� Page number /
�.CJ (o
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or
March 1, wrrent ye�r owneR ❑ Yes ❑ No
If name on record is different than that of applicant, indicate below:
of mortgagee or contract
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contracl seller (numl�kr and street, city, state, ZIP
(
Name of assignee or other owner or holder oi mortgage
Address of assignee (number and st2et, city, state,
Does applicant own propeAy in any other I If yes, whe
county in Indiana?
approved in the amount ot:
20 ��
Signature
20
DS-3�z6 ""
20 �'� 20 20
I
County Auditor
Is the propeRy
❑ Real Proper
�
❑ Moble Home (IC 6�1.1
Has this dedudion been requested on
property for wrrent year? � Yes ❑ No
�
Date
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March t, 20
�natur ners ful me) Person authorized by duly executed Power of Attorney
�„ , � 4/ or by IC 6-1.1-12-.07
resident adQr�ss of applicant Address of authorized person
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