HomeMy WebLinkAboutMortgage_IvySTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� , Sfate Fwm a3709 (R4 / 10-07)
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PrescribeE by Department of Local Govemment Finance
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INSTRUCTIONS: � � -•,rFile.� �
To be filed in person or by mail with the County Auditor of the county where the property is /ocated. €�
Filing Dates: 1) Real Property: Dunng the 12 monfhs be)ore May 11 of the year the deduction is to ffecSLe.jL/
2) Mobile Homes assessed �nder IC 6-1.1-7: Belween January 15 and Ma�ch 31 of the year the deduction is to be effective.
See reverse side for additronal instructions and qualifica6ons. A N K 1 1 2003
(owner or contract
Assessed value of real property as
March 1, wrrent year
If no, what is his / her exact share of interest?
on reverse
Key number /
Rewrd
GI3SOtd COU�TY A! �DITOR�
, �(�; ��/rl�� Q O Page number
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MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owne(? ❑ Yes ❑ No
�SO00
If owned with someone other lhan spouse, indicate with whom.
If name on record is different than ihat of applicant, indicate below:
of mortgagee or contrad seller
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of moRgagee or conVact seller (number and stieet,
of assignee or other owner or holder of mortgage
of assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
Deduction approved in the amount of:
20
Signature
20 �/
state, ZIP
What Taxing Distrid?
COUNTY AUDITOR
20 os 20 t➢� 20
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County Auditar
❑ Real Properly ❑ Mobiie Hortie
Has lhis dedudion been requested on
property for current year? Q Yes ❑ No
20
20
/ We certify under the penalty of perjury that the above and foregoing infortnation is irue and corred and that the applicanls was / were
i resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person