HomeMy WebLinkAboutMortgage_Jamerson��� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES�
= FOR DEDUCTION FROM ASSESSED VALUATION
�• _ d Sta:e Form a3709 (RS / a-03)
�� N PrescnCetl by Department of Loral Govemment Finance
INSTRUCTIONS: '
To be filed in person or by mail wiih the County Auditor ot the county where the property is
Filing Dales: 1) Real P�operty: During the 72 months 6e(ore May 11 0/ the year the deduction is ro�f(eAti�. Z�QS
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 olthe year the deduction is to be e/%ctive.
See reverse side !or additional instructions and quali�cations. � ��a-�
_ '._.,...� rril INTY AUDITOR
(owner�i
Distrid
Assessed value of real
March 1, currenf year
- see
as of
If no, what is his / her exact share of interest?
name on record is different than that
ime of moAgagee or contrect
side)
Key �lmber / legal description
number
D�y / _ � f,/ �7� �T Page number
U 10 (/iv7 -C.(.�
Mortgage / ContraU indebtedness unpaid as of Is the applicant the sole legal or equitable
Rlarch 1, current year owner? ❑ Yes ❑ No
/0 � (�0 0
If ow�ed with someone other than spouse, indicate with whom.
indicate below:
Address of mortgagee or contract seller (number and st�eet,
Name of
Address
or other owner or holder of mortgage
(num6er and street, city, state, ZIP code)
Does applicant own property in any olher I If yes, what countv?�
county in Indiana? - - - - -
s the property in questian:
❑ Real Property ❑ Mobile Home (IC 61.1-
�'(.�,�',S.
ZIP
What Taxing District?
Drawer NO.. D�,-, � ��L
� JDITOR
Deduction approved ii Card NO . .....................
200 (a 2( ` �
P �- � I � P zo
Signature _
County Audifor
Has this deduction been requested on
propehy for current year? [I Yes ❑ No
�
20
�We certify under the penalty 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
3nat wners full nam/e)�/ Person authorized by duly executed Power of Attorney
.�,: ,(!^„_.., n�...n or by IC 6-1.1-12-.07
ent atltlress oi apqkcant IAddress of authorized person
� �L 3 � 2(�R �