HomeMy WebLinkAboutMortgage_Hulfachor� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
♦ / State Fortn a3709 (RS / 4-03)
�• Presaibed Gy DepaMiem of Local Govemment Finance
INSTRUCTIONS: � � a FiI�Nt�rk�
To be filed in person or by mail with the Counry Auditor of the county where the property is located.� � g�J �J �.l
Filing Dates: 1) Real Property: Dunng fhe 12 months be%re May 11 of the year the deduction is to be eNective.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of tAe year tl�/�d `�tran2�Qfibe eNective.
See reverse side lor additional inshuctions and qualifications.
Applicant (owner r c ntract bu
Taxing Disirid �
on reverse
�
(��,�. be 7- o � 9r�-�d Page number ��`
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or
March t, current year March 1, currenl year ownef? ❑ Yes � No
���Oc�
If no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
mortgagee or contraIX seller
Address of mortgagee or cont�ad sefler (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
(numberand street, city, sfate, ZlPcode)
Does applicant own. ���
« I.IMY�� �
— Dra�ver �O• °Z�Q.F.-�.........
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Dei Card N�•�'�'�0��
— 1�� O
20SI� 20_[� 201J�
P P �
Signature
❑ Real Properiy � Mobile Horne pC Cr1.1-�
wunty? Whal Taxing Dislrid? Has this dedudion been requested on
property for wrrent year?� Yes❑ No
COUNTY AUDITOR
20
County Auditor
20
�
Date
20
We certify under the penalty of perjury lhat the above and foregoing information is true and correct and lhat the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
full
Person authorized by duly executed Power of
or by IC 6-1.1-12-.07
of applic9nt �� � ,� �Address of authorized person