HomeMy WebLinkAboutMortgage_Burns.�
��
�
STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm a3709 (RS / 4-03)
PresmDed by Department of Local Gtivemment Financa
INSTRUC710NS:
To be filed in person or by mail with the County Auditor of the county whe2 the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months 6efore May 11 of the year the deduction is to b� (��e�� 2003
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o%the year ihe d duction is to be eflective.
See reverse side for additional instructions and qualifications.
� � �iBSOt� CO NTY A��
.-.
March 1,
contract
of real properiy as of
year
If no, what is his / her exacl share of interest?
rt ons n reverse s
�
Ke umber / Iegal description Record number
O 3- 3 7
�� _ _ Page number
Mortgage / Contract indebtedness unpaid as of Is lhe applicant the sole legal or eq
March 1, current year owneR �'Yes ❑ No
/ J`� �/�/
If owned with someone olher than spouse, indicate with whom.
If name on record is different than lhat of appticant, indicate below: Is lhe property in question:
B'I�eal Property ❑ Mobile Home (IC 61.1-�
;�me of moRgagee or contrad seller
f'0%.�f1,0
Address of mortgagee or contract seller (nu er and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage Q�^ S("� !� �
DrawerNO ...................
Address of assignee (number and street, city, state, ZIP code)
CardNO . .....................
Does applicant own property in any olher I If yes, what county?
county in Indiana?
ii �pil n ('�!��
De uction approved in the amount of: �
J
zo zo zo
�w""
Signature
NTY AUDITOR
Zo
-�
County Auditor
20 �� zo �
i° P
Date
been requested on
t year? � Yes 0 No
Zo
We certi(y under the penalty of perjury lhat the above and foregoing infortnation is lrue and corred and ihat ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
name)
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
F II resident address of a�plicant Address of aulhorized person
� �wA� � %%ti .. _ �