HomeMy WebLinkAboutMortgage_Trapp� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
? FOR DEDUCTION FROM ASSESSED VALUATION
� M� ♦ State Fortn a3709 (RS l 4-03) �
� Prescri�ed by DepartmeM of Local Govemment Finance
INSTRUCTIONS:
Coun Township Year
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To be )iled in person or by mail wifh the Counry Auditor of the county where the property is located.
Filing Dates: 1J Real Property: During the 12 months before May 11 o/the year the deduction is to be'eflective. � � n
2) Mobile Homes assessed under IC 6-1J-7: Between January 15 and March 2 0( the y�ear the deduction�is to ben ective.
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See reverse side for additional instructions and qualiTcations. � GI_�SOtJ CGL��TY tiUDfTC^. .
Applicant (o er or confract buyer- s e t�ction on reverse side
Taxing Distrid Key number / legal description Record number �
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant t e sole legal or equitable
March 1, current year March 1, wrrent ye2r �� owner? ❑ Yes ❑ No
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ii no, what is his / her exad share of interest? If owned with someone other ihan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�ame of mortgagee or contract seiler �� '/�� „ ������
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Address of mortgagee or contract seller (number and street, city, state. ZIP
Name of assignee or other owner or holder oi mortgage
Address of assignee (num6er and sfreet, city, state, ZIP code)
Does applicant own property in any other I If yes, •+���at co�mty % ��a^�-•-�-- =-- ^°--=-�^ �-"^--•�'- '-'-�'--'- :en requested on
county in Indiana? � ea�� Yes� No
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� Dra�r�er NO ...................
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COUN7 LIO� �
Deduction approved in the amount o(: CaCd ��. .... � ................
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Signalure County Auditor Date
�I/ We certify under the penalty of perjury that the a5ove and foregoing information is true and corred and that the applicants was / were
� resident of Indiana and owner of the aforementioned property on March 1, 20
Signat (owners full ame/ . Person authorized by duly executed Power of Attorney
.� � or by IC 6-1.1-12-.07
ull resident address of applicaN f-r-%-�� .. Address of authonzed person �
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