HomeMy WebLinkAboutMortgage_Pfohl�� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' � FOR DEDUCTION FROM ASSESSED VALUATION
�• / Sta;e Fwm a3709 (RS / 4-03)
� M PresrnDed by Department ol local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o! the county where the property is located.
Filing Dates: iJ Real Property: Dunng the 12 months be%re May 11 0l the year the deduction is to be e/(e�y 1'� 2005
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the year fhe deducti is to be eNective.
See reverse side /or additional instructions and qualifications. �� ��
_. /1 . r�RSON COUNTY AUDITOR
buyer ;see re�ncj(yfis on reverse
`
Assessed value of real property as of
March t, wrrent year
1(ey number / legal c�cription �
�D 7 �b/9��-oa
Mortgage / Contract indebtedness unpaid as
March 1 ent year
number
Page number
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Is the applicant the sole legal or
owner? ❑ Yes ❑ No
/ 'E' �� V �.J
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diKerent Ihan that of applicant, indicate below: Is ihe property in question:
� n �, ❑ Real Property ❑ Mobile Home (IC 61.1
mortgagee or contract seller
Address oi mortgagee or contract seller (number and sfreef, cify, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other I If yes, what county? I What Taxing District?
county in Indiana?
Deduction approved in the amount of:
zo o i � Zo
P I �
Signature
Drawer NO....a.�� ....
` Card NO. .... ay��.....
�Ic��Joco°�—
..�unry Huanar
Has ihis dedudion been requested on
property for curreM year?� Yes� No
zo
Date
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We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned properly on March 1. 20
�n�aWre wners full r�e) � Person authorized by duly executed Power of Attomey
��l �`—dy"�� or by IC 6-1.1-72-.07
�ull res�tlenYaddress of ap�pJfcant ' n (� Address of authorized person
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