HomeMy WebLinkAboutMortgage_McClellan (2)N" STATEMENT OFMORTGAGE OR CONTRACTINDEBTFnuGCc
:� FOR DEDUCTION FROM ASSESSED VALUATION
S�� � Slate Form a3709 (R4 / iP-0t)
�\ PrescribeC by Department of Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o/ the counfy whe2 the
Filing Dates: 1) Real Property: During the 12 months be%re May 11 01 the year
2) Mobile Homes assessed under IC frf.l-7: Behveen January 15 and March 31 0/ the
See reverse side for additional insbuctions and qualifications. � �
Applicant (owneiorcontra t uyer- see restrictions on revers side) �
�
Taxing Distrid Key number / legal description
1(Yicrn�- �ps -p i ar�- �
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as
March 1, wrrent year March 1, cu-rent year � � � C� 0
If no, what is his / her exacl share of interest?
If name on record is different lhan that of applicant,
.
Record number
be effective.
Page number ^ �
O�
( Is the applicant ihe sole legal or equitable
ownef? ❑ Yes ❑ No
If owned with someone other lhan spouse, indicate with whom.
'ame of mortgagee or contrad seller
_ 5�3
Address of mortgagee or contrad seller (number and st2et, city, state, ZIP
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 if yes, what county? What Taxing Distrid?
county in Indiana?
COUNTY AUDITOR
20 n•a
Signature
approved in the amounl of:
20 �� I 20 � I 20 [2Ca_
County Auditor
20 � 7
❑ Real
O Mobile Home OC 67.1-
Has this deduction been requested on
property for wrrent yeaf? �] Yes ❑ No
20 ��
/
Date
20
/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
res�ent of Indiana and owner of the aforementioned property on March 1, 20
gn ure (owne/s full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person
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