HomeMy WebLinkAboutMortgage_Allen (2)�
: ♦
�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fom; a3709 (RS I a-03) �
Presaibed �y Department of Local Govemment Finance
Coun Township Year
__.� �
INSTRUCTIONS: File Mark
To be �led in person or by mail with !he County Auditor o/ the county whe�e the property is located. MAR 1 i) 2�06
Filing Dates: 1J Real Property: During the 12 months before May 11 01 fhe year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year fhei�dµctioN ts to be eHective.
O �� /�a�
See reverse side for additional instructions and qualifrcations. �/ Cl
. GIBSON COUN?Y AUDITOk
Applicant (o r rcontract 6uyer- s restncti on reverse side)
Taxin District Key number / legal description Record number ��
�^ � � � ,�y� Page number � �
iJ w
Assessed value of real.property a of MoAgage 1 ContraC indebtedness unpaid as of Is lhe applicant the sole egal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
If no, whal is his / her exad share of interest? Ii owned wilh someone other than spouse, indicate with whom.
If name on record is different than thal of applicant, indicate below: Is lhe property in queslion:
�� ❑ Real Property ❑ Mobife Home QC 61.1-�
�me of mortgagee or contrad seller , ONg
� � -� a5
Address of mortgagee or contrad seller (number and street, city, state, ZIP o 0_�.( 0 5 3
0 �
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code) .
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
counry in Indiana? property for current year?� Yes� No
COUNTY AUDITOR
Deduction approved in ihe amount of:
20 20 _Q � 20 �� 20 20 20 20
� P
Signature County Auditor Date
We certify under the penalty of peryury that the above and foregoing information is true and corred and that lhe applicants was / were
. res' nt of Indiana and owner of the aforementioned property on March t, 20
i ature (owners full name) Person authorized by duty executed Power of Attorney
�� � or by IC 6-1.1-12-.07
F ident add s of apphcant Address of authorized person �
yc