HomeMy WebLinkAboutMortgage_Buentert�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�• / SWte Form a3709 (R5/4-03)
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Piescnbad 6y Departmem of Local G6vemmeM Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor o! the county where the property i� r�^�t� �� �
Filing Dates: 1) Real P�operty: During the 72 months be%re May 11 of the year the deduc ��,is 6 effec
2J Mobile Homes assessed under IC 6-1.7-7: Between January 15 and Marchg o! t y u s to be eNective.
See reverse side lor additional instructions and qualiTcations.
MAY 1 3 2005
(owner
District
buyer-.
Assessed value of real property as of
March 1, wrrent year
no, what is his / her exacl share of interest?
side)
umber / legal description
��1 - � � �� -0
/ �
., '
Page number
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or f
March t, wrrent year owner? ❑ Yes ❑ No
l0 4�O'a %000�
If owned with someone other than spouse, indicate wiih whom.
If name on record is different than that o( applicant, indicate below:
�me of moAgagee r contract seller
Address of mortgagee or contrad seller (number an sf�eet, c y,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, slate, ZIP code)
Does appf—�-� � / � /
county in I
NO.� .....
Drawer ........
ZIP
What Taxing Disirict?
Card NO . ..............
......• �TyAUDITOR
Deduction a
20 � 20 ()� 20�_ 20 20
� � /
Signature County Auditor
Is the property in question:
❑ Real Propery ❑ Modle Hwne (IC &7.
Has this deduction been requested on
property for current year? � Yes ❑ No
+3�7
20
We certify under the penalty of perjury that the above and foregoing information is irue and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
applicant
y7E
Person auihorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
person