HomeMy WebLinkAboutMortgage_Hoefling"'rt�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i4 °- .� FOR DEDUCTION FROM ASSESSED VALUATION
��: j� Slate Porm a3709 (R4 / 10-01)
Prescnbed tr/ Deparlment o/ Local Govemment Finance
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INSTRUCTIONS:
To be filed in peraon or by mail with the County Auditor o1 the county �vhere the property is located. N � � 1� 2��4
Filing Dates: i) Real Property: During lhe 12 monfhs before May 17 0/ lhe year the deduction is to be e ective.
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ the r fhe dedu io ' fo be elfective.
See reverse side �or additional instructions and quali�calions. GI830N COU TV
AUDI70R
Applicant (owner or contract buyer - see restnciions on reverse side)
, . �i � ,� r'1� �_�r'... n/� lf _ „C_ l�
(in�on T ��sG�i �
Assessed value of real property as of
March 1, current year
If no, what is his I her ezact share of interest?
Key num er / legai desuiption � � Record number
, '
MoAgage / Contrect indebtedness
March 1, currenl year
.�
Paqe number
as of I Is the a
owne(?
DoO
If owned wit meone c
�( l l' Q' CJ �1 — lJ V 1• JJF� V�Ilf' �,
on record is different t han that of applicant, indicate below:
of mortgagee or wntraU seller
A d ss oi rtgagee or contrad seller (n mber and street, city, state, ZIP
,. . �. ,., ---1 , . . � G�-l- i /il ln 4 � �
Name of assignee or other owner or holder of rt
Address of assignee (num6er and street, city, state, ZIP
�r than s�ouse
�0�
ov -
; the property
� `f36 %
ant the le legal or equitaF
� ❑ No
whom.
❑ Real Property ❑ Mobile Home (IC 61.7
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduciion been requested or
counry in Indiana? property for current year?� Yes❑ N
Deduction approved
T�7
Signature
amount of:
20 � �/ � 20
COUNTY AUDITOR
�
� I P
_ County Auditor
20
20
Date
20
�k
I I We certify under the penalty of perjury lhat the above and foregoing information is true and correcl and that the applicanls was / were
� a resident of Indiana and owner of the aforementioned propeAy on March 1, 20
Signafure (owners full name) � Person authorized by duly executed Power of Attorney
� �/ �� E �/ ,�/. orbylC6-1.1-12-.07
K. OMM / rze�r:�r.�9
�
address
of authonzed person