HomeMy WebLinkAboutMortgage_Miller (5)�
z
� ,.� �
STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn a3709 (RS / 4-03)
Coun Township Year
PtescriGetl by Depertment of Loral Govemment Finance
�J RUCTIONS: File Mark
� filed in person or by mail with the CountyAuditor o1 the county where the property is located.
Filing Dates: 1) Real Property: During the 12 montbs before May 11 of the year the deduction is to 6e effective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year theq.deducti� is t�eftective.
See reverse side for additional instructions and quali�cations. q�� �j �
�i^ }� ���
� r
Appticant (owner or contract buye - s rest ' tionsbn revers Q C ' Q
,tl n0
Taxing District Key number / le al description Rec r number ��t,��-^���� /l�
� ., rn�1N�Y AU��SD e7
� ' 03 �OOY Pag n6i$ber�� �02
4
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitahle
March 1, curtent year March 1, current year owner? ❑ Yes ❑ No
i O
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
� Real Property ❑ Mobile Home (IC E1.1-7)
Name of mortgagee or contract seller
ress of mortgagee or contract seller (number and street c y, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, stale, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for curtent year? 0 YesO No
COUNTY AUDITOR
Deductlon approved in the amount of:
20 20 20 20 �J 20 _Q� 20 20
� � 9 � �
Signature County Auditor Date
I/ We certify under the penalty of perjury that the above and foregoing infortnation is true and correc[ and that the applicants was / were
a resident of Indiana and owner oi the af oned property on March 1, 20
ure ownef ull n e Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
� FuU r ident address of app icant Address of authorized person
o �. � '�
OWLNSllI //I[ �J 7L65