HomeMy WebLinkAboutMortgage_Brown (7)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' ' FOR DEDUCTION fROM ASSESSED VALUATION Coun Township Year
�. � � Sldte Form <3709 (R4 / 10-07)
w.
Prescribetl by DepaNnent uf Lwl Govemment Finance
� ;� � 1 jt ?`1
INSTRUCTIONS: �i ���Ie�Mark��
To be filed in person or by mail with the County Auditor o! fhe county whe2 the property is Ixated. �'� �-�.J �
Filing Dates: 1) Real Property: Dunng the 12 months be%2 May 11 0l the year fhe deduction is to be effective���� �;
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and March 31 0/ the yea�the deduction is taQ�Hective.
See �everse side for additional insfiictions and qualifications.
Appliwnt
Taxing Distrid
buyer-see
Assessed value of real property as of
March i, current year
H no, what is his / her exad share of interesl?
If name on record is diiferent than that
mortgagee or contrad
on
Key number /Aehal description
V'
�//-o1�3y-oo
MoAgage / Contrad indebtedness unp<
March 1„qt�rrent year
c�
Address of mortgagee or contraIX selier (number and street, city,
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st�eet, city, state, ZIP code)
Record
as of
: number 5 a a �
Is the applipnt lhe sole legal or equitable
owneR ❑ Yes ❑ No
� � I
If owned with someone other than spouse, indicate with whom.
Does applipnt own property in any other If yes, what county? What Taxing Distrid?
county in Indiana?
Deduction approved in the amount of:
zo �y
�
Signature
COUNTY AUDITOR
20 �_ 20 c !< 20
P � �'
County Auditor
20 ��
�
❑ Real
� Mobile Home pC 6-1.
Has this dedudion been requested on
property for current yeaR � Yes ❑ No
20 �`� I 20
.�
' We certify under lhe penalty of perjury that the above and foregoing infortnation is true and corred and thal lhe applicants was / were
resident ot Indiana and owner of the aforemenlioned property on March 1, 20
Person authorized by duly executed Power
or by IC 6-1.1-12-.07
ull esi ent address of appliqnt - Address of authonzed person
l7 Cl 1 inv<v l�l'-Z /\ 11 1 i� m r(' �n �Tt�l