HomeMy WebLinkAboutMortgage_Hedges (4)`°rt"�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`+�-' , 4 FOR DEDUCTION FROM ASSESSED VALUATION
S�y SWte Porm a3709 (R4 / 10-01)
���\ Prescribed by DeDartment ol Local Govemment Finance
INSTRUCTIONS: �
To be filed in person or 6y mail with fhe County Auditor o! the county whe2 the property is loc�`g� 2 r� �nn,
Filing Dates: 1) Real Property: During the 12 months be7ore May 11 of the year the deduction is lo be erNe K1�`
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and M 31 of the ear t e deducfio is to 6e effective.
See reverse side (or additional instructions and quali�cafions.
GIBSON COVA' Y !-UDI � OR
Applicant (owner or co ra buyer - see 2striction o reverse s' e)
Taxing Distrid Key number / legal d ription Record number �
�
3a� od Page number ^O �
or
Assessed value of reat propert as of Mortgage / Contract indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, current year March 1 current year owner? ❑ Yes ❑ No
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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 applicanl, indicate below: Is the property in question:
❑ Real Property ❑ Modle Hane (IC 61.1-�
��e of mortgagee or contreIX seller
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Address of mortgagee or contrad seller (number and street, cify, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant ow� property in any other If yes, what counry? What Taxing Distric[? Has this dedudion been requested on
county in Indiana? property for wrrent yeaf? � Yes � No
COUNTY AUDITOR
Deduction approved in lhe amounf of:
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Signature County Auditor Dale
�`Ne certify under the penalty of perjury that the above and foregoing information is true and corred and lhal the applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
Signatu e(owners full nam Person authorized by duly executed Power of Attomey
n. or by IC 6-1.1-12-.07
�L.
F I re ident address o appli n Address of authorized person
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