HomeMy WebLinkAboutMortgage_Wessley�� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
z FOR DEDUCTION FROM ASSESSED VALUATION
1• �! State Form a3709 (R514-03)
�� PissaiCeC Oy Depanment of local Govemment Finance
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor of the county where the property is locarea.
Filing Dafes: i) Real Property: During the 12 months before May 11 of the year the deduction is to be eBective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 75 and March 2 of the year the deduction is to be eftective.
See reverse side for additional instructions and quali�cations.
7
Taxing
see restnctions on reverse side)
Assessed value of real property as of
March t, current year
no, what is his / her exacl share of interest?
Key number / legal descr'�on Record numberoLl _^�� �
/ �
DO/ _ Q��� �� Page number
�o
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owner? �es ❑ No
� �
If name on record is different than that ot applicant, indicate below:
mortgagee or contract selier
If owned with someone
Address of mortgagee or wntract seller (nu�er and st��et, city, sfate, ZIP
��3
��Q a-�� �_ a 5- 3 i I
Name of assignee or other owner or f�older of mortgage
Address of assignee (numbe� and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? I What T
county in Indiana?
20 �
�
SignaWre _
�3-� _ii . G
in the amount of:
20�` 2011�
� �
COUNTY AUDITOR
20 0� 20
P
County Auditor
than spouse, indicate with whom.
OS- 3yy3
zl Property ❑ Mobile Home QC 67.1-�
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Drawer NO. v , r.; ��✓��o
Card IVO . ..................... i o�
� No
20
Date
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�/ We cedify under the penalty of perjury that Ihe above and foregoing information is true and correct and that the applicants was / were
a resident of Indiana and owner of ihe aforementioned property on March 1, 20 '�
��i nalure (o ers lull na ) Person authorized by duly executed Power of Attorney
������ ..�i� or by IC 6-1.1-12-.07
�es� f applicanl� / �' IAddress of authorized person
if� —�i--