HomeMy WebLinkAboutMortgage_Gaultney;i � STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
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'�`i' �= FOR DEDUCTION FROM ASSESSED V SI N
J State Form a3709 (R6 / 5-06) ��� �
� Rwtribed by Department of Laal Govemment Finarxe �� 1tJ
NUV z 6 2007
INSTRUCTIONS:
Count Tcwnship Year
File Mark
To 6e /iled in person or by mail with the County Auditor of the county the� �s located.
Filing Dates: 1J Real Property: Du�ng the 12 months before June Il o�fK�i�� the�uction is to be eftective.
2) Mobile Homes assessed under IC 6-1.1-7: Betwqg�g�qyayp(gJ�7fd�PRo(the year fhe deduction is to be eNective.
See reverse side (or additional instruclions and quali(rcations.
Applicant (ownerorcontrac yer= see restndio s on verse side
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Taxing DistriG . Key number / lega escription cord number0
Page number �� �
G?� a�-1 1_-ia - 400 001. s a -o
Assessed value af real property as of Mortgage / Contrad indebtedness unpaid as of . Is the applican the s e legal or equitable
March 1, current year ' March 1, cunenl year owneR "�es ❑ No
%s
If no, what is his / her exact share of interest? . If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicanf, indicate below: Is the property in question:
I Property ❑ Mobile Hame QC 61.1-n
e of mortgagee or contrad seller �
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Address of mortgagee ar contrad seller (number and street, city, state, ZIP
Name o1 assignee or other owner or holder of mortgage
Address of essignee (number and street, city, state, ZIP code)
Does appGcant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for wrrent yeaf? � YesO No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �_ 20 0 20 20 20 20 20
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Signature County Auditor Dale
We ceAify under the penalry of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duty exewted Power of Attomey
3� or by IC 6-1.1-12-.07
Full resident address oi ap licapi / /��7� �O Address of authorized person
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