HomeMy WebLinkAboutMortgage_Grisham Investments Inc��� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
• FOR DEDUCTION FROM ASSESSED VALUATION � g� Township Year
�• �� ! Siate Form a3709 (RS I a-03) g
� Prescn0etl �y DeDartment ol Local G6vemment Finance
MAY 0
INSTRUCTIONS: File Mark
To be filed in person or 6y mail with the County Auditor ol the county where the prope� a
Filing Dates: 7) Real P�operty: Dunng the 12 months 6e(ore May 1 f oI the year the d€duci�is to effective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 8�ldA(i�BiTtYe ��i��deduction is to be effective.
See reverse side Ior additional insfructions and qualifications.
Applicant ( r o� contract buyer - see tnctions on rever e side)
�
Taxing Distrid Key numbe legal description Record number D�
' 1 1 � � � _ D / ��' r' �O Page number / / ?�
'f J C� d
Assessed value of real property as of �� Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legai or equitable
March 1, current year March 1, current year owner? ❑ Yes ❑ No
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 different Ihan thaf of applicanf, indicate below: Is ihe propeAy in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�ame of mortgagee r contract seller
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or hoider of mortgage
� O L `O -
Address of assignee (number and slreet, city, slate, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for current year?� Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �i G, 20 � 20 �6 20 O`2 20 20 20
� � � �
Signature County Auditor Date
�/ We certify under the penalty of perjury Ihat lhe above and foregoing in(ormation is irue and corred and that the appiicanis was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Signature ners full name person authorized by duly executed Power oi Attorney
/ � or by IC 6-1.1-12-.07
F II sident address of applicant Address of authorized person