HomeMy WebLinkAboutMortgage_Stone (2)e`° R�"° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
e�+�`-" : FOR DEDUCTION FROM A$SESSED VALUATION Count Township Year
; y S�ate Fofm a3709 (R4 / 10-07)
o.
Prescribetl by Depannent of Local Govemment Finance
To beRUC�TION rson or by mail with the Counly Auditor o/ the county whe�e the property is�e� �-� F�k
Filing Dates: 1) Real Property: During the 12 months be%re May 11 of the year the deduction is �p��e�ectivg:
2) Mobile Homes assessed under IC 6-1. 7-7: Between January 15 and March 31 ot�f e fhe�Qjction is to be effective.
See reverse side /or additional instructions and qualifications.
Applicant
Distrid
Assessed value ofre�
March 1, wrrent year
Ii no, what is
exact share of interest?
reverse side)
Key number / legal description Rewrd number �y�
v
b� 5- o/ � � � � °a Page number �� �
MoRgage / Contrad indebtedness unpaid as of is the applicant the sole legal or equitable
March �ent year owner? ❑ Yes ❑ No
j Ooc"7
If owned wilh someone other than spouse, indicate with whom.
If name on record is diHerent than that of applicanf,
of mortgagee or contrect seiler
Address of mortgagee or contract seller (number
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand st�eet, city, state,
below:
city, state, ZIP
Does applicant own property in any olher If yes, whal county? What Taxing District?
countyinlndiana?
Deduction approved in the amount of:
20 �,�
Signature
p�l/�FZi7
COUNTY AUDITOR
20 O (L
1
County Auditor
20
property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
Has this deduction been requested on
property for current year? Q Yes ❑ No
20 �
Date
�
We certify under the penalty of perjury that the above and foregoing intortnation is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March t, 20
name)
Person authurized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
�nt address of applicant Address of authorized person
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