HomeMy WebLinkAboutMortgage_Hammer��* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
F FOR DEDUCTION FROM ASSESSED VALUATION
�• Sute Form a3709 (R51 a-03)
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PresuiOetl �y Department ol Local Govemment Finance
INSTRUCTIONS:
To be tiled in person or by mail with the CountyAuditor of the county where the property is located.
Filing Dates: i) Real Property: During the 72 months be%re May 71 of the year the deduction is to be eflectiv�AY 9 2005
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 75 and March 2 0l the year the deduction is to be effective.
See reverse side lor additional instructions and qualifications. �"%j� ,Q�
, GIBSON COUNTY AUDITOF
(owner
Taxing Disl'
� ����
on reverse side)
Key number / legal description
�//- cn��a -� r
number
number
�Do a�
/ %D �
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the appliwnt the sole legal or equitable
March 1, current year March 1, current y ar owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than thal of applicant, indicate below: Is ihe property in question:
mortgagee or contracl seller
Address of mortgagee or contrad seller (number and street, city, state,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana? 1
Deduction :
20 �
�
Signature
Drawer NO...q���.. ..
Card NQ. ....�.l.Q.y
-� �51i 5(e I . ao .......
What Taxing District?
�UNTY AUDITOR
!o � 20
P
Couniy Auditor
❑ Real Property ❑ Mobile Home QC 61.1-�
Has this deduction been requested on
property for current year? � Yes � No
zo
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/ We certify under the penalty of perjury that the above and foregoing iniormation is true and correct and that lhe applicants was / were
resident of Indiana and owner o( the aforementioned property on March 1, 20
name)
or by IC 6-1.1-12-.07
duly executed Power of Attorney
Ui resident atldress of applicant Address of authorized person
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