HomeMy WebLinkAboutMortgage_Fravel�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
,� w� ✓ SWre Form a3709 (RS 14-03) (�
PrescriEed by Departmenl of Local Govemment Finance � J
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INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 72 months before May 11 olthe year the deduction is to be effective.
2) Mo6ile Homes assessed unde� IC 6-1.1•7: Between January 15 and March 2 0/ the year the deduction is to be ef/ective.
See reverse side (or additional instructions and qualifrcations.
Applicant (o er r contract 6uyer - ee restri i ns on reverse id )
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Taxing Disiri ey number / legal description Record number
� QO �� OI'' Q� Q M Page number
-1 r� 6 -r��.�
Assessed value of real property as f MoAgage / Contract indebtedness unpaid as of Is the applican he sole legal or equitabte
March 1, wrrent year March 1, wrrent year owner? ❑ Yes ❑ No
� V V�
If no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
me of moAgagee or contract seller
Address of mortgagee or contract seller (number and street. city, sfate, ZIP
, os-���y
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 If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for wrrent year?� Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � 20 � 20 D� 20 _� 20 20 20
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Signature County Audilor Date
1 We certify under the penalty of perjury that ihe above and foregoing information is true and correct and ihat the applicants was / were
., resident of Indi �a and owner of the aforementioned property on March 1, 20
S' atu (owne s(ull name) Person authorized by dufy executed Power of Attorney
or by IC 6-1.1-12-.07
F I sident address of applicant Address of authorized person