HomeMy WebLinkAboutMortgage_Lankford (3)an
STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
•. w� ! Siate Form a3709 (RS / 4-03)
� Pmscribed by Department of local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o/ the county where the property is located. p 9
Filing Dates: 1J Real Property: During the 12 months be%re May 11 o/the year the deduction is to be �eLYi�t. 1 Z��6
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be elfective.
See reverse side (or additional instnictions and qualifications. �/j �,Q�
� GIBSON COUNTY AUDITOR
Applicant
Taxing
Assessed value of real property as
March t, current year
see
If no, what is his / her exact share of interesl?
Ke number /1� al descri tion � �
y g p Record er
b O � Pagenumber /_C.Q7
IJJCJ /
Mortgage / ContraG indebtedness unpaid as of Is the applicant the sole legal or eqi
March 1, wrrent ear owner? ❑ Yes ❑ No
�
If owned wifh someone other than spouse, indicate with whom.
�-iq-i� - ao3-oo�. a3�-�ac�
If name on record is different than that of appliwnt, indicate below:
,me of mortgagee or contracl seller
Address of mortgagee or contrad seller (number and st2et, city,
assignee or other owner or holder of mortgage
Address of assignee (number and stmel, city, state, ZIP code)
Does applicant own property in any other I I( yes, what county? What Taxing District?
�m�.+fii.in.lndiana7
Dra���er \'O ��........
COUNTY AUDITOR
Card N� ivo"oo'�o" 7'........
,
� n��.�a,� �,�
_� �` � � � �
Signature
zo
County Auditor
zo
Is the property in queslion:
❑ Rea� Property ❑ Mobile Home QC 61.1-�
5-7�7�
0 7- ay3
Has this dedudion been requested on
property for wrrent year?� Yes❑ No
zo
Date
�
We certify under the penalty of perjury that the above and foregoing information is true and corred and ihat ihe applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
address of applidant U — �Address of authorized person