HomeMy WebLinkAboutMortgage_Sabo� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS �
FOR DEDUCTION FROM ASSESSED VALUATION o own" ip Year
�. � / State Form a3709 (RS / a�3)
� PrescnbedbyDepenmentotLOCalGovemmentFinance FEB � L���
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INSTRUCTIONS: ��� �File`I�ark
To be filed in person or 6y mail with the CountyAuditor of the county where the property is Iocate�IBSON CbUNfiY AUpli§Fi
Filing Dates: 1J Real Property: During the 12 months be%re May 11 0l the year the deduction is to be e7iective.
2) Mo6ile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 of the year fhe deduction is to be eNective.
See reverse side Ior additional instructions and qualifications.
Applicanl
Tacing
contract
0
�f real
year
as
- see
Ii no, what is his / her exact share of inleresl?
on reverse side)
Key number / legal description Record number
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�� /}�„/j�%� Pagenumber ^ n/ /�
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Mortgage / Contract indebtedness unpaid as of is the applicant the sole legal or E
March 1, current year �1 �� OC� . O� owneR ❑ Yes ❑ No
J
/ �� ,
If owned with someone olher than spouse, indicate with whom.
name on record is different than that of applicanf, indicate below:
.me of moRgagee or contraU seller
�/ \�r7 /yICLL
Address ot mortgagee or contracl seller (number and sfreet, ciry, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and stmet, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
co••^w in Indiana?
Dl-a►ver t\'Q
4:�-t�,`vo. .
4cLQ �
1
Signature
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What Taxing District?
COUNTY AUDITOR
zo
County Auditar
�
Is the property in question:
❑ Real Property ❑ Mobile Horne (IC 61.1-�
Has this dedudion been requested on
propeAy for current yeaRO YesO No
zo
Dale
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certify under the penalty of perjury that the above and foregoing information is true and corred and lhat the applicants was / were
lent of Indiana and owner of the aforementioned property on March t, 20
Person authorized by duly
or by IC 6-1.1-12-.07
KFuII resid�rft address of applicant `� Address of authonzed person
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