HomeMy WebLinkAboutMortgage_Davis (11)d� R•n t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i-` : FOR DEDUCTION FROM ASSESSED VALUATION '1 - Year
� �y S�ate Fortn a3709 (Ra I 70.07) �
�Prescnbed by Departnent ol Loral Govemment Finance
INSTRUCTIONS: le Mark
To 6e filed in person or 6y mail with the County Auditor ol the county whe2 the property is loc d. �
Filing Dates: 1) Real Property: Dunng the 12 months belore May 11 of the year the deductioryt �°�
2) Mobile Homes assessed under IC 6-1.7-7: Behveen January 15 and March 31 0/ the�year �Tductlbi�Ts�t� 6e eNective.
See reverse side lor additional instnictions and quali�cations.
Ap licant wner or contract buyer - see r nctions on reverse side) .
� �
Taxing DistriG Key number / legal description Record numbe� f� u��
7
� Q � _ G �/� Page number
Assessed value of real property as of Mortgage / Contrect indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, current year owner? ❑ Yes ❑ No
� �� �
Ii no, what is his / her exact share of interest? If owned wilh someone other than spouse, indicate with whom.
If name on record is different than ihaf of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC fr1.1-�
me of mortgagee or contrad seller �m
\ / /"�,��/C.S.
Address of mortgagee or contrad selier (number and street, city, state, ZIP O
�'G •
Name of assignee or other owner or holder of mortgage �
D
Address of assignee (number and street, city, state, ZIP code) �(� —3 O�
n^� ���1�•
y,ty.�`
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for wrrent year7 � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20�_ 200 20 fZ(� 20 20 � 20�9
dR— o°A � P P �' P
Signature County Auditor Date
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
e resident of Indiana and owner of the aforementioned property on March 1, 20
Sig atur wners full name) Person authurized by duly executed Power of Attorney
` or by IC 6-1.7-12-.07
�resi ent address of applicant Address o( authorized person
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