HomeMy WebLinkAboutMortgage_StilwellR�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- !: FOR DEDUCTION FROM ASSESSED VALUATION
S� / State Form a3709 (R4 / 70-01) �
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� PrescribeA by DeDariment W Lofal GovemmeM Finance
INSTRUCTIONS: �
To be filed in person or by mail with the County Auditor o! the county whe2 the propeRy is loc� n(�
Filing Dates: 1) Real Property: Dunng the 12 monfhs be%re May 11 0) the year the deduction Is'YUb�el��VE�.3
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and Ma/�c/f� 31 0/ the year the deduc��tion is to 6e effective.
See reverse side (oradditional instructions and qualifications. � /L, .���,, , _//�
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Appticant (owner or ontrac u e- see restrictions o re ers ide)
Tauing D' 'd ey number / legal description Record number O 2
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Assessed value of real property as of Mortgage / Contred indebtedness unpaid as of Is the applicant the sole legal or equitable
March i, current year March 1, current year ownef? ❑ Yes ❑ No
I( no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different lhan that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobite Home pC 61.1-�
�ame of mortgagee or conVad seller
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Address of mortgagee or contrad seller (number arid st2et, city, state, ZIP
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Name of assignee or other owner or holder of mortgage �
Address of assignee (num6er and st2ef, city, state, ZIP code)
Does apptipnt own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for curcent yea(? � Yes❑ No
COUNTY AUDITOR
Dedudion approved in the amount of:
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Signature Counry Auditor Date
I/ We ceAify under lhe penalty of perjury that lhe above and foregoing informalion is true and corced and that ihe applicants was / were
residenl of Indiana and owner f the aforemenlioned property on March t, 20
Sign e lull name) Person authorized by duly exewted Power of Attomey
ar by IC 6-1.1-12-.07
ull resi nt add ss of applipnt Address of authorized person
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