HomeMy WebLinkAboutMortgage_Tepovich�STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�� 1" FOR DEDUCTION FROM ASSESSED VALUATION
State Forrt; a3709 (RS I a-03)
,� PrescnOed by Depanment of Local Govemment Finance
INSTRUCTIONS:
Coun Township Year
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`Jti 1 �F��KA"ark
To be (led �n person or by mail with the County Auditor of the county where the property is located., n
Filing Dates: 1) Real Property: Dunng fhe 12 months 6efore May 11 of the year the deduction is to be effective. � ���
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0( fhe.year-the deduction'is"fo.tie effective.
See reverse side for additional instructions and quali�cations.
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Applicant
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Assessed value of real property as of
March 1, current year
If no, what is his / her exact share of interest?
Key numb�r / legal description I Record number O�
D o� -ba��� -06 Page number / � /�
,o
Mortgage / ContraU indebte�ess unpaid as of Is lhe applipnt the sole legal or equitable
March�rrent year /�� O � owner? ❑ Yes ❑ No
(��C�O(� `.P '
If owned with someone other than spouse, indicate with whom.
I
If name on record is different than that of appiicant,
of mortgagee or contraG
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Address of mortgagee or coniract seller (number and street, city, state, ZIP
Name ot assignee or other owner or hottler ot mortgage
Atltlress ot asslgnee (numberand st2et, dty, sfate,
Uoes applicant own property in any other I If yes, what county?
wunty in Indiana?
Deduction approved in the amount of:
20
Signature
zo oa
�
s the property in questfon:
❑ Real Pioperty ❑ Modle Hortie (IC Et.t-�
3- �c,z
Drawer NQ...D 3�CO ��Z
Card NO. .. . ..... ..
W � �" an requested on
:ar?� Yes❑ No
COUNTY AUDITOR
20
County Auditor
r� . '
20 �_ 20
P
Date
We certify under the penalty of perjury that the above and foregoing information is true and correcl and that the applicants was / were
�esident ot Indiana and owner of the aforementioned propeRy on March t, 20
y��n t r (owners (ull name) , Person authorized by duly executed Power oi Attorney
nn� jo��,,��n� yn0 orbylC6-1.1-12-.07
address of applicant � �Address of authorized person