HomeMy WebLinkAboutMortgage_Jones (6)�n
STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
`' �'� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
5�.._ / State Fom: a3709 (RS / a-03)
�M� � �—�
Prescn�etl Dy Department ot Loral Govemmeni finance �� ��j' I� j� \\
� f' fi
1i .iLS ls.� �=�
INSTRUCTIONS: GEP 1 � 200§ile Mark
To be filed in person or by mail with the County Auditor of the county where the property is located.
Fi/ing Dates: 1) Real Property: Dunng the 12 months belore May 11 0/ the year the deduction is to 6e e�ective. n �
2) Mobile Nomes assessed under IC 6-1.1-7: Between January 15 and Marcii 2 0/ the.year the�deduction is to 6e effective.
1`��.,.�.-�fLJ�` �'.�.�
See reverse side for additional instructions and qualifications. � � Ci°SON CO:;` � Y:.UDI7G3 �
Applicant
DisVict
contract buyer- e restr
n � Q �—� d
�i�.. �:►�
Assessed-balue of real property as of
March 1, current year
If no, what is his / her exact share of interest?
Key number / legal description
• !
Record number
" O - d �!
oO J`1 —� 3 58'_� Page number
MoRgage / Contrect indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneR ['fYes ❑ No
If name on record is different lhan that of appliwnl, indicate
Name of moRgagee or contraclpseller
� �X�
Ii owned with someone other than spouse, indicate with whom.
Address of mortgagee or contrad sQfer (number and street, city, state, ZIP
Name ot ass�gnee of othef ownef of holtlef ot mortgage
Atltlress of assignee (number antl st2et, dty, state, ZIP
property in questfon:
al Property ❑ Mobiie Home (IC 61.1-�
Drawer I�TO. � :3 =..7.°..`��'
Does applicant own property in any other I If yes, what counry? I�a Cal'd NO. requested on
countyinlndiana? ��������������������� ?DYesONo
Deduclion approved in the amount of:
20
Signature
COUNTY AUDITOR
20 �� � 20 �� � 20 F� -1 � 20 �_
�
County Auditor
20 C15
Date
20
1/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
'�sident of Indiana and owner of the aforementioned property on March t, 20
address
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-72-.07
of authorized person