HomeMy WebLinkAboutMortgage_Slagle�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S � State Fom: <3709 (RS / 4-03)
�n�
� Prescrib¢d ty Departrtrent of Local Govemment Finance ��
� 0 r �
INSTRUCTIONS: � � � � � Mark
To 6e filed in person or by mail with the County Auditor of the county where the property is locat� O � Z��7
Filing Dates: 1J Real Property: Dunng the 12 months before May 11 0( the year the deduction � be eSective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the year the deduction is to be eHective.
See reverse side for additional instructions and qualificatrons. /�j �%� ��"
� GIBSOh Cv /yTY ��TOR
Applicant
Assessed value ofrealproperty
March 1, wrrent year
no, what is his / her exact share of
If name on
Key number / legal de rip ion f
z�-id-�-ao3- o/iss�-oa�
066 -r� �s� ;� _ . f
Mortgage / Contracl indebtedness unpaid as of
March 1, cur t year
�� / �� �
than that of applicant,
moRgagee or conirect seller
Address of mortgagee or contract selier (number and street,
Name of assignee or other owner or holder of mortgage
Address of assignee (num6e� and sfreet, city,
Does applicant own propeAy in any other I If �
county in Indiana?
Dedudion approved in the amounf o�:
20
Signature
20 O �
p
number
number
owneR
O /
S�O
I the sole legal or equitable
❑ Yes ❑ No
Ii oWned with someone other than spouse, indicate wilh whom.
below:
i
cit te, ZIP
�
C
Dra���er i\'0........
aoo� _ �--, • ..*...
ca�-d �vo. .. �
e�`�-° �4:�.� �,Q��.:
�7s; oop,o�
20 �_ 20 20
P
County Auditor
s the property in question:
❑ Real Property O Mobile Hane (IC 61.
Has this deduclion been requested on
property for current year? � Yes ❑ No
20
Date
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
e�erS�
�-cn� ��
4�E�
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person