HomeMy WebLinkAboutMortgage_Owenrt�� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
F FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�. � � / State Form a3709 (RS / a-03) �
� PrescnDeO by Depanment of Laal Govemment Finance �
iNSrRUCr�on,s: pPR 2 7 2005 File Mark
To be filed in person or by mail with the CountyAuditor of the county where the property is located.
Fi/ing Dates: 1) Real Property: During !he 12 months before May 11 0/ the year the deduciion is fo 6e eff �.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 g�t�ieqe� duction is to be e(fective.
See reverse side /or additional instructions and quali�cations. C,�gSON COUNTY AUDITOR
Applicant (owne� or contracl
axin District �
t �
Assessed value of real prop�
March 1, current year
on rey�erse side)
number / legal
Record number
,, Q� �/,� / QQ /� Q O Page number ��
V
as of Mortgage / ContraG indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year a t,� �� owner? ❑ Yes ❑ No
(��L�v �1
no, what is his / her exact share of interest?
If name on record is different lhan that of applicant, indicate
mortgagee or contrad seller
Address o( mortgagee or contract seller (number
Name of assignee or
Address
owner or holder of mortgage
(number and st2et, city, state, ZIP
city,
Does applicant own property in any other If yes, what counry?
county in Indiana?
Deduction approved in fhe amount
20
Signature
If owned with someone other than spouse, indicate with whom.
Is the property in question:
❑ Real Property ❑ Mobile Hwne (IC 61.1
Taxing Disirict? Has this dedudion been requested on
property for current year?� Yes� No
COUNTY AUDITOR
20 � I 20 �_ 20 � I 20
�� //
County Auditor
20
Date
20
/ We certify under the penalty of peryury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and ovrner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07 �
Full residenf agdress of aPplicant Address of authonzed person
� . �, . C�n1 . 3°5�1 G �r, nt�e�l.