HomeMy WebLinkAboutMortgage_Britton� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Co own ear
S / State Form a3709 (R5 / 4-03)
�«•
� PtesaiEetl by Department of local Guvemment Finance E C 2 8 2005
INSTRUCTIONS:
To be filed in person or 6y mail with the CountyAuditor of the county whe2 fhe property is located.
Filing Dates: 1) Real Property: During the 12 months be%re May 11 oJ the year the deducUon is to be e�t�� COUNTY AUDITOR
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be efiective.
See reverse side for additional instructions and qualifications.
S
(owner or contract buyer- see restrictions on reverse
Taxing Disirid
Assessed value of real property as of
March 1, curtent year
If �io, what is his / her exact share of
Key number / legal description � Record number
0�� � ���
Morigage / Contred ir
March 1, cunent year
If name on record is diHerent than that of appli�ant, indicate beiow:
mortgagee or contrad seller
Page number
-b� aga
ness unpaid as of Is the applicant�sole legal or
owneR es ❑ No
�
If owned with someone ofher than spouse, indicate with whom.
of mortgagee or contract selier (number and street, cify. state, ZIP
N2me of assignee or other owner or hoider of mortpaqe
of assigner. (numtrer and streel. city, s�ate. ZIP code)
Does applicant own nrcperty in any oth�r I I! •��; g�hat cvunty?
county ir indlana? �
Deduction approved in the am����it nf:
2�
Signature
I
Is the property in question:
❑ Mobile Home QC G1.1
��G�-�/�C "'/ ���
J t� �3�--'� s -a-af
p�c✓0 S � O��^I
4Vhat Taxing Distrid? Has this deduction been requested on
property for current yea(? � Yes ❑ No
COUNTY Al1DITOR
--I 2�_��__ ----i 2C_� 2o i 20
I
_ _� _ _�__�___J_______ �_
___,_ ._ __ __ County Auditor
20
Date
20
vdc rr�tiP�r unAer tn� �,,.nalty of per;���- iL•�� 1ne above and forepoina info: maYUn is hu� and corred and �hal ihe applicants was / were
�esi!ient of Indiana a��d owner of rhA afn�emeMioned property on March L 20
sidenl adrl!ess of aD�licant
S I I t� F,'��- eu
:�h� �F:766�
Person a�iihorized 6y duty executeA Power of H�tomey
or by IG 6-1.1-12-.07
Address of authnnzed person