HomeMy WebLinkAboutMortgage_Angle2� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�• �w� ! Sta:a Fortn a3709 (RS / a-03)
�� PrescriDeO �y Department o! Local Govemment Finance
INSTRUCTIONS: APR 2 File Mark
To be filed in person or by mail with fhe CountyAuditor of the county where the property is located. � 2�05
Frling Dates: 1) Real Property: During the 72 months be%re May 11 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 75 and March 2 0/ the year`�g,cjeduc�to� to 6e effective.
v �
See reverse side /or additional instructions and qualificafions. OIBSON COUNTY AUDITOq
Applicant
Key
on reve/�e side)
/ legal description � Record number
..
Assessed value o( real property as of Mortgage / Contract ii
March 1, wrrent year March 1, current year
S
If no, what is his / her exact share of interest?
If name on record is different than that of appliwnt, indicate betow:
of mortgagee or contract
Name o(
Address
of mortgagee or contrad
(number and
or other owner or holder ot mortgage
(num6erand street, cify, state, ZIP
Does applicant own property in any other I If yes, what county?
couNy in Indiana?
Deduction approved in the amount
20 � (v I 20
� // {9 � Page number !� � O �
�rc��� a
btedness unpaid as of Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
state, ZIP
What Taxing Disirid?
COUNTY AUDITOR
20 �7� 20 �� 20
P
County Auditor
Is the pi
❑ Real
❑ Mobiie Home (IC 67.1-�
, �.
Has this dedudion been requested on
property for current year?� Yes� No
20
20
' We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
3 r o ners lull (�'dme) Person authorized by duly executed Power of Attorney
�� �j Q or by IC 6-1.1-12-.07
� . \/ � .
1 ./� /� _ � IAddress of auihorized person