HomeMy WebLinkAboutMortgage_Houseknecht� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
•� �� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
State Fom: d3709 (R5/4-03)
Prescnbed by DeOanment of Local Govemment Finance
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RUCTIONS: File Mark�
To 6e filed in person or by mail with the County Auditor of the counry where the property is located.-� F' , �}, ',
Filing Dates: 1) Real Property: Dunng the 12 months 6efore May 11 of [he year the deduction is torbe eflecti've. ,� }��
2) Mobile Nomes assessed under IC 6-1JJ: Between January 15 and March 2 of fhe yearithe}deduction ir's;, t)o b�e eBective.
See reverse side for additional insfructions and qualifrcafions. � SE� 1 S Z�11-Y�
Appli � ner or cont a t buyer - se resMctions on reverse side)
i axing ui «ia Key number / legal description
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�i4��1��4 1 w P o o�- ov��.r o
Assessed value of real property as of
March 1, current year
If no, what is his / her exact share
Record number
Page number ��/ D
Q
Is lhe applicant lhe sole legal or equitable
owner? ❑ Yes ❑ No
Mortgage / Contract indebtedness unpaid as of
March 1, current year
`�/f� d�z�
If name on record is difterent than that of applicant, indicate below:
N=me of mortgagee or contrad seller
of mortgagee or contrad seller (number
Name of assignee or other owner or hoider of mortgage
If owned with someone oiher than spouse, indicate with whom.
city, state, ZIP
.\ddress of assignee (numberand street, cify, state, ZIP code)
Is the property in question:
❑ Real Property ❑ Modle Home pC 61.
Does applicant own property in any other I If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current year?� Yes❑ No
COUNTY AUDITOR J
Deduction approved in the amount of:
��O I 20 � I 20� I 20
Coun�y Auditor
2� � I 2� � I 2�
I � I
I/ We �^;5"ry under ihe penalty of perjury that ihe above and foregoing information is true and correct and that the applicants was / were
�asident of Indiana and owner of the aforemenlioned property on March 1, 20
(owners (ull
it address applicant
Z e.� 2GGC
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person