HomeMy WebLinkAboutMortgage_Parker�'� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
'F FOR DEDUCTION FROM ASSESSED VALUATION Coun s Year
,• I Sute Fom. a3709 (R5 / 4-03)
«
PrescnEed by Depanment ot Laal G6vemment Finance
uvsraucriorvs: MAY 1 � 2�
File Mark
To be filed in person or by mail with the CountyAuditor of the county whe�e the property is located. �
Filing Dates: 1) Real Property: During the 72 months before May 11 0l the year the deduction is to be e�� R
2) Mobile Homes assessed under IC 6-1.1-7: Beiween January 15 and March 2 0l the year flfe d�rpn b48�be eNective.
See reverse side /or additional instructions and qualifications. G�gSON
App' owne�orcontra buyer- erest�clionso re rse ide)
�
Taxing District Key number / legal description Record number _ �
O I l— GU � 1'—� � Page number
lo(_)
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March t�current year owner? ❑ Yes ❑ No
41�����
y,
If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicale below: Is ihe property in question:
❑ Real Property ❑ Mobile Home (IC &1.1-�
�3me of mortgagee or contrect sell r
Address of mortgagee or contract seller (num r and st2et, cify, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and s6eet, city, state, ZIP code)
Does applicant own propeAy in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for current year? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounf oi:
20 D l_ 20 O 20 �_ 20 �C� 20 20 20
� Q -� P
SignaWre County Auditor Date
�/ We certify under the penalty of perjury that the above and foregoing information is irue and corred and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
i re (owne/s full name person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Full resident address of applicant —� Address of authorized person