HomeMy WebLinkAboutMortgage_Miller (34)�
� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S ! State Fartn a3709 (RS / 4-03)
w
� Prescribed by Depertment of Local Govemment Finance
f"t
INSTRUCTIONS: �{ � �i_/ � ' f�-.J'
File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located. (�� ,� �oo�
Filing Dates: 1) Real Property: During the 12 months before May 11 of tbe year the deduction is to be ef�cf�lve. `%
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the.year the de/duction is tonbe e/lfective.
See reverse side /or additional instructions and qualifications. �—f�����
„ GBSON CJOU�iI Y AUUTOR
or wn�ract buyer - see re�af�ictions on
Assessed value of real property as of
March 1, cunent year
If no, what is his / her exact
Key number / legal description � Record
, ���777 .. ��
� j/Y}� _ �/�/ • ���—� Page number /J���
o ilA� �/ / Q
Mortgage / Contract inde�edness un aid as of Is the applicant the sole legal or
March 1, current year �Q �/��Q , owner? ❑ Yes ❑ No
/c �3, ���
If name on record is different than that of applicant, indirate below:
��ne of mortgagee or contrect seller
�p�
Address of mortgagee or contrect seller (number and street, ciry, s
of assignee or other owner or holder of mortgage
and street, ciry, state, ZlP code)
If owned with someone other than spouse, indicate with whom.
ZIP
❑ Real Property ❑ Mobile Home (IC 61.1-7)
� /�1 _ ,� . �. S' .
Does applicant own property in any other If yes, what county7 What Taxing Dislrict? Has this deduction been requested on
county in Indiana? , property for current year? ❑ Yes❑ No
r/\, �
Deduction approved in the amount of: �y`� �� n��
/
�U
20 O 20 ¢� 20 � 20� 20
Pj'lQ"i30ii � � , P
Signature
�ounty Auditor
Date
We certify under the penalty oi perjury that the above and foregoing infortnation is true and cortect and that the applicants was I were
'esident of Indiana and owner of the aforementioned property on March 1, 20
Y7(�70
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person