HomeMy WebLinkAboutMortgage_Landford`'rt�'' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'e' '"" .: FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S�y State Fofm a3709 (R4! 70.01)
u�.
� Prescribcd by Oepatlment ol Local Govemment Finance _
INSTRUCTIONS: ile �p'�ar
To be filed in person or by mail with the County Auditor o/ the county whe2 the property is lo ed. ��� 1J'
Filing Dates: 1) Real Property: During fhe 12 months be%re May 11 of the year the deduction is fo �ref�ective.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 of th {e6r t��ll�aon is to be elfective.
See reverse side for additronal instructions and quali�ca6ons.
(owneror
Taxing District
Assessed value of real property a� of
March 1, current year
If no, what is his / her exact share of
ti�/ns on verse side)
/
Key number / legal description
(�CJG � �j/(O �'�-�.J
number
number
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or
March 1, current year owne(? ❑ Yes ❑ No
If name on record is different than ihat of applicanl, indicate below:
If owned with someone olher than spouse, indicate with wnom.
❑ Real
of mortgagee or conlract seller Q���
./
Address of mortgagee or contrad seller (number and st2et, city, state, ZIP
Name of
or other owner or holder of mortgage
Address of assignee (num6erand st�eet, city, state, ZIP code)
❑ Mobile Hame (IC 61.
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
couniy in Indiana? property for current year?� Yes� No
COUNTY AUDITOR
approved in the amouni of:
2
20�_ 20 20 Q� 20 �_
County Auditor
20 � ��
�
20 �
Date
20 � �
,� P
certify under the penalty of peryury that the above and foregoing information is true and corred and that the appiicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of applicant . U ^ �Address of aulhorized person