HomeMy WebLinkAboutMortgage_Martin (2)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION �
S � J Sute Fwm C3709 (RS / 4-03) �
� Prescnbetl Dy Depanment of Local Govemmanl Finance
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor o) the county where the property is located.
Filing Dates: 1J Real Property: During the 12 months belore May 11 0! the year the deduction is to 6e ef
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 oJ the year
See reverse side for additional instructions and qualiircations.
or contract buyer -
�
Record
`/f`� a �� /� �% O �/Y �O Page number
lJ �o� 7
JAN S � 2006
�
v � „�`.. lU �/
v ue of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
wrtent year March 1, current year ownef? ❑ Yes ❑ No
��' J poo 0
,
Ii no, what is his / her exact share of inlerest?
If name on record is different than that of applicant, indicate below:
of moAgagee or contract seller
owned wifh someone other than spouse, indicate with whom.
Address of moRgagee or contrad seller (number and stieet, city, state, ZIP
assignee or other owner or holder of moRgage
Address of assignee (numberand street, city, state, ZIP code)
Does applicant own property in any olher If yes, what counry?
couniy in Indiana?
20
approved in the amount of:
20 Q �
u
What Taxing Distrid?
COUNTY AUDITOR
20� 20 20
County Auditor
Is the property in question:
❑ Real Prope�ty ❑ Mobile Home (IC 61.1-�
Has this deduction been requested on
property for current year? 0 Yes ❑ No
20
Date
3�]
certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
ir ow rs (ull name) � Person authorized by duly executed Power of Attomey
����. ,�j A�r , or by IC 6-1.1-12-.07
of authorized person