HomeMy WebLinkAboutMortgage_Holcomb (3)STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
ti � State Form a3709 (R4 / 70-07)
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� PrespiDeO Dy DepaNren� of Local Govemment Finanre
INSTRUCTIONS: N O V � �e�
To be filed in person or by mail with the County Auditor o( the county whe2 the property is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ the year the deduction is to effective. �a�' „ �
2) Mo6ile Homes assessed under IC 61.1-7: Behveen January 15 and March 31 oJ t year t d`Juce � is to e ctive.
See reverse side foradditional instructions and qualifica6ons. GIBSON COUhTY .4UDITOR
Appli nt ownerorcontra t 6uy r- see resMc6ons on rs ide)
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Taxing/D'�isirid // Key number / legal description Record number Q�
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Assessed value of real property as of MoAgage / Contrad in�btedness unpaid as of Is the applicant the sole legal or equitabie
March 1, curtent year March 1, current year (Q �Q �j� owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different ihan that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
me of mortgagee or conVact seller /
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Address of mortgagee or conVacl seller (number and street, , state, ZIP
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Name of assignee or other owner or holder of mortgage
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Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distriq? Has this deduction been requested on
county in Indiana? property for wrtent yeaf? � Yes ❑ No
COUNTY AUDITOR
Dedudion approved in the amount of:
20 �,� 20 �_ zo � 2o f� (� zo � zo a v zo
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Signature County Auditor Date
�� We certity under the penalty of perjury that the above and foregoing infortnalion is true and corred and lhat the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power of Attomey
,� ' or by IC 6-1.1-12-.07
Full resident address of applipnt Address of authorized person
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