HomeMy WebLinkAboutMortgage_Boling� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VAIUATION Coun Township Year
� µ State Form a3709 (RS / 4-03)
� PiesrribeA by Departm:nt ot Local Govemment Finance
INSTRUCTIONS: � File �ark
To be filed in person or by mail wfth the County Auditor of [be county where the property is located.�,{� �� ��
Filing Dates: 1J Real Property: During the 12 months before May 11 01 the year the deduction is to eHe �v
2) Mo6ile Homes assessed under IC 6-1:1-7: Befween January 15 and March 2 of the year t e e uchon is to be eHective.
See reverse side for additional insfnictions and qualifications.
JAN 1 0 2006
Applicant (o r or contract 6uyer- see restri ions on reve side) • ~ 6`a
U
r�acryni COUNTY AUDITOR
Taxin Distrid K number / legal desaip ion Record number ��
0 D 4- D D� �-f� Page number �
Asses d value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, cunenl year owner? ❑ Yes � No
a5 �
If no, what is his / her exact share of interest? If owned wilh someone other than spouse, indicate with whom.
If name on record is different Ihan that of appiicani, indicate below: Is the property in queslion:
❑ Real Property ❑ Mobile Home (IC 61.1-�
me of mortgagee or contrad seller
Address of mortgagee or cont�act seller (number and street, city, te, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, sfate, ZIP code)
Does applicant own property in any other If yes, what couniy? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for curtent year? � Yes � No
COUNTY AUDITOR
Dedudion approved in the amount ot:
20 � 1 20 �� 20 � 20 20 20 20
P P �
Signature County Aud'Aor Date
.'� We ceAify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
' natur (owners full name) . Person authorized by duly exewted Power of Attomey
Ro� by �� 6-,.,_,2-.0�
F I resi ent address of applican i ln ,, L,���.F Address of authorized person
��� Z V �7 39