HomeMy WebLinkAboutMortgage_Schleter� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDN
' FOR DEDUCTION FROM ASSESSED VALUATION � o n nship Year
�. �� . State Form a3709 (R5/ 4-03)
N �
''�Prescnbed Dy Depertment of local Govemment Finance U N 1 0 ZO 5 �~v�
INSTRUCT(ONS: - � . � �'6� FileMark
To be liled in person or by mail with the County Auditor ot the county where the property i�I���COUNTY AUDITOR
Filing Dates: 1) Real Property: Dunng the 12 months be(ore May 11 0/ the year the deduc �on is to be e/%cfive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be effective.
See reverse side for additionaf instructions and qualifications.
Appl (owner or contract buyer - ee 2stn 'ons on reverse s' e)
c{- �
Ta�cing Distrid Key number / legal desaiption Record number
o G
00 �_ O� I p � Page number
O
Assessed value of real properiy as of Mortgage ! Contrad indebtedness unpaid as of Is the applican� ihe sole legal or equitable
March 1, wrrent year March 1, current year owner7 ��es ❑ No
� j<,
I( no, what is his ! her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
� ❑ Real Property ❑ Mobile Hmie QC G1.1-�
�me oi mortgagee or conVact seller. '
Address.of moAgagee or contract seller (number and street, city, state, Z!P
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does appliwnt own propeRy in any other If yes, what counry? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? . , property for wrrent year? � Yes❑ No
N li.� <Sw 1- 3- 1U I_ 3 COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 D q 20 20 20 20
Y 1 �
Signature Couniy Auditor Date
� We certify under the penalty of perjury lhat lhe above and foregoing information is true and corred and that ihe applicants was ! were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Si nature (o n s ull name� Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Fu I r ident address ot applicant Address of authorized person
R/�j 2 B[� Y/f r7', �/??nG /7 �i1/ �f �6 `t 4`
i