HomeMy WebLinkAboutMortgage_Riley�� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
F FOR DEDUCTION FROM ASSESSED VALUATION
�. / Sta;e Fortn d3709 (RS / d-03)
� PrescnDeO by Depanmem ol Lacal Guvemment Finance
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor o/ the county where the propeRy is located.
Filing Dates: 1) Real Property: During the 12 months be%re May 11 0! the year the deduction is to be eHea�t� 5
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 olthe year the dedu�tion �s��3e elfective.
See reverse side for additional instructions and qualifications. �� ��
Applicant (owne :onf�act buyer- �
Taxing Dist id
.
� �
Assessed value of real property as of
March 1, wrrent year
If no, what is his / her exacl share of i
reverae
GIBSON
Key number! legal description Recor�umb�
Q 1�..� 1�� — Q � Page number
l �
�
MoAgage / ContreG indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, wrrent year owner? ❑ Yes ❑ No
� O6a O
If name on record is different than that of applicant,
of morigagee or contracl seller
Address of mortgagee or contract seller
If owned with someone other than spouse, indicate with whom.
below:
street,�ity, stafe, ZIP
or other owner or holder of mortgage
of assignee (numbe� and st2et, city, state, ZIP code)
Does applicant own property in any other I If jres, what county? What Taxing District?
county in Indiana?
20 o Ci
�
Signature
approved in the amounf of:
20
COUNTY AUDITOR
20 e � 20 �
�
Couniy Auditor
20
Is the property in question:
p Real Property ❑ Mobile Hane (IC &1.1-�
Has this deduction been requested on
property for wrrent year?� Yes� No
20
Date
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
�nature (owners (ull name) Person authorized by duly executed Power of Attorney
���� � /�Q �� � or by IC 6-1.1-72-.07
resident address of appiicant `� �Address of authorized person
R /2 3 � �5 3 F ��••...tl�.