HomeMy WebLinkAboutMortgage_Gayso�:�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
1 FOR DEDUCTION FROM ASSESSED VALUATION o nt T hi Year
`�� State Fwm a3709 (R6 / SO6)
��• Presrnbed 6y Depariment of Lonl Govemment Finance
INSTRUCTIONS: � Fi�B,�yark
Q � ��S�a'Y
To be filed in person or by mail with the County Auditor of the county where the property is located. U �/
Filing Dates: 1) Real Property: During the 12 months be%re ,lune 11 of fhe year the deduction is to fl81�ffp7p�(CpUNTY AUDITOR
2) Mobile Homes assessed under IC 6-7.7-7: Between January 15 and March 2 of the year the deduction is to be effective.
See reverse side lo� additional instnictions and quali(ications.
Applicant (owner or contract buyer- see restrictions o revers i)
G'I� � v�.xCJ �vrt¢% -
Taxing Distrid Key number / legal d cription
ojlo -/7 - D/- 4��`�—
000. Y96 - o � �.
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of
March 1, current year March 1, cunent year
g ?, �o v
what is his / her
If name on record is
of interest?'
that of applicant, indicate below:
of mortgagee or canVad seller�/�
Record number
Page number
S�I•l:�
5sv
Is the applipnt the sole legal or
owneR ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contrad selier (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sGeet,
Does applicant own property in any
county in Indiana?
Deduction approved in the amount of:
20 �_ 20 �
P �
Signature
state, ZIP code)
Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.
Dra�ver NOO�Q�•� �'S6
�ard NO :...: .:.:....... �' ad
37%I � `�, �� ap ,
If yes, what counry? � What Taxing Distrid?
COUNTY AUDITOR
20 20 20
County Auditor
Has this deduction been requested on
property for current yeaR 0 Yes❑ No
�
Date
20
certify under the penalty of peryury lhat the above and foregoing information is true and corred and that the applicants was / were
I� of Indiana and owne��f the afor�rn�tioned property on March 1, 20
name)
or by IC 6-1.1-12-.07
UII reStlent atltlress of ap�lipnt - . /! /. Address of
S o n,��? l�D, gax� �""'°"_",..,._
� 4�bbs �
person
Power of