HomeMy WebLinkAboutMortgage_Livermore (2)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
� w! Siate Fwm a3709 (R5 / 4-03)
� PresuiEed by Department of Lotal Govemment Finance
Coun Township Year
INSTRUCTIONS: FEB 1�12�%
To be Cled in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1j Real Property: During the 12 months be%re May 11 olthe year the deduction is to be ef/ective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the year th'e deductiavis•to 6e effective.
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See reverse side Ior additional insfructions and qualifications. p�g��yN C6ljNfiY AydIT�R
Applicant (owne� or
as of
It no, what is his / her exac[ share of interest?
reverse
Key number / legal description Record number
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Q� �� Q' � Q �/" OO ` Page number
l7
Mortgage / Contrect indebtedness unpaid as of Is lhe appli�
March 1, current year � owner?
�@AK.�1�n q �,�bo.
If name on record is different than that of applicanf, indicate
�me of mortgagee or contrad seller
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Address of mortgagee or contreIX seller (number and street,
Name of assignee or other owner or holder of moAgage
below:
Address of assignee (num6er and street, city, state, ZIP code)
Does appiicant own property in any other If yes, what counry?
counry in Indiana?
Deduction approved in the amount of:
20 C �� I I 20
t the sole legal or equitable
❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
state, ZIP
What Taxing District?
COUNTY AUDITOR
20 �9 20 20
P
County Auditor
Is the property in question:
❑ Real Rnperty ❑ Mobile Home (IC 6�1.
Has this deduclion been requested on
property for current year?� Yes� No
20
20
ceAi(y under the penalty of perjury that the above and foregoing information is tme and correct and thal ihe applicants was / were
ient of Indiana and owner of the aforementioned property on March 1, 20
name)
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Person authorized by duty executed Power of Attorney
or by IC 6-1.1-12-.07
Address ofauthorized person