HomeMy WebLinkAboutMortgage_Moeller/a%��� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�i��; FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
: � / State Fwm a3709 (R6 / 5-06) � � ' -
� Presaibed by Department of lonl Gwemment Finance
INSTRUCTIONS: Fil rk
To be (iled in person or by mail with the County Auditor o/ the county where fhe property is I t �
Filing Dates: 1) Real Property: Du�ng the 12 months before June Il o(the year the deductio s o�e cti� ,
2) Mobile Homes assessed under lC 6-1.1-7: Belween January 15 and March the y a� e e uct�on �s to be e/fective.
See�eversesideforadditionalinstructionsandqualifications. �E� 2 g Z���
or
Taxing
Assessed value of real
Marcj� 1, current year
If no, what is his / her exad
as of
ofinterest?
�pns on erse side) Q�la� ti� .
� I GBSON COUNTY AUDITOR
Key number / legal description Record number ��
�lo- ( $-aV--10 .bt�-�C�3�-o Pa e number -7s � -�j
MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owner? ❑ Yes ❑ No '
� �06500� �
I( owned wifh someone olher than spouse; indicate with whom.
If name on record is different than that of applicant, indicate below:
�e of mortgagee or contract seller
Addreas of mortgagee or contrad seller (number and street, city, s
of assignee or other owner or holder of mortgage
(number and street, city, state, ZIP
Dces applicant own property in any oiher I If yes, what county?
counry in Indiana?
Deduc6on
zo
Signature
' � . � 1 1 •
❑ Real PropeAy � Mobile Home (IC 61.1-�
"i _ .
What Taxing District?
COUNTY Auniroa
in th i 9
ia�ver NO.Q� �° ?Sf
..............
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' u�d NO . .....................
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zo
a
Has this dedudion been r
property for current yeaR
zo
Date
zo
iestetl on
YesO No
certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
lenl of Indiana and owner of the aforementioned property on March 7, 20
ire ers lull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
�ident address applicantG Address of authorized person
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