HomeMy WebLinkAboutMortgage_Lyons"'rt�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
er —.. � FOR DEDUCTION FROM ASSESSED VALUATION
�4 w y Sta;e Fortn a3709 (R4 / 10.01) -
Presc+ibe0 by Department of Local Govemment Finance
Count � Township Year
. �"
INSTRUCTIONS: �"r Fle Miark ( � �� �
To be filed in person or by mail with tbe County Audifor of the county where the property is located. �- �,(� ��
Filing Dates: 1 J Real Property: During the 12 months before May 11 0/ the year the deduction is to be eNective.
2) Mobile Homes assessed under IC 6-1J-7: Behveen January 15 and March 31 07 the year the de�ct�on Is to �yHective.
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See reverse side lor additional instructions and qualifrcations. �' „
Applicant (owner or contract buyer - see resMctions on reverse sitle)
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Tacing Distrid Key number / legal descripti
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Assessed value of real property as of I Mortgage / Contract ir
March 1, current year March 1, current year
If no, whal is his / her exact share of interest?
If name on
'� 1 l.�', 0 D D
�-o��. a��-�d�
than that ot applicant, indicate
mortgagee or contract seller
Record number
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Page number ^ �� _
unpaid as of I Is the applicant the;ale legal or
owne(? �es ❑ No
If owned with someone other ihan spouse, fndicate with whom.
Address of mortg�agee or contrad seller (number and slreet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP code)
property in quesnon:
� ❑ Modle Home QC 61.7
OF-.. lSf �/
Does applicant own property in any other If yes, what county? What Taxing Dislrict? Has lhis detluctlon been requesteo or
county in Indiana? property for current year? 0 Yes ❑ N
Deduction approved in the amount
20 20
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Signature
COUNTY AUDITOR
20 0 + 20 �j_ 20
P �'
County Auditor
20
Date
20
I/ We certify under the penalty of perjury that the above and foregoing information is true and correcl and that the appiicants v+as / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
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Person auihonzed by duly executeo Nower ot Httomey
or by IC 6-1.1-12-.07 .
of authorized person