HomeMy WebLinkAboutMortgage_Dailey� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
:� M� / State Fwm a3709 (RS / 4-03)
� Presaibed by Department of Local Gtivemment Finance
INSTRUCTIONS:
To 6e �led in person or 6y mail witA the CountyAuditor of the county where the property is locatetl.
Filing Dates: 1J Real PropeRy: Dunng the 12 months before May 11 01 the year the deduction is to be eft�'�e.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the/ y�ear the deducti /�'���o be eHective.
See reverse side for additional instructions and qualifications. (l �/ L/ n n
Applicant (ownerpra
0I (�..-
Taxing Dislrid
buyer - see restrictipns on
Key number! legal description
GIS$p�� (;�j�j� Y nU O
Record number O �
6oC I.—/'� /��� ^!� Page number �
—i v � �.�c�
Assess value of real property as of MoRgage / Contred indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, wrtent year March 1, current year ownef? ❑ Yes ❑ No
3D��
If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different than ihat of applicant, indicate below:
�me of mortgagee or contract seller
.ti7 1 �1 l,!
Address of mortgagee or contracl seller (number and st2et, city, s
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other I If yes, what county?
wunty in Indiana?
20
approved in the amounl
20
ZIP
What Taxing Distrid?
COUNTY AUDITOR
20 (5 � 20 �
P
County Auditor
20 �_
P
s the property in question:
❑ Real Pioperty ❑ Mobile Home QC 61.1-�
Has this deduclion been requested on
property for current yeaR Q Yes 0 No
20
Date
�
ceAify under the penalty of perjury thal the above and foregoing information is true and corted and that lhe applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
x Z03
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
person