HomeMy WebLinkAboutMortgage_Armstrong (5)ry� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
� F FOR DEDUCTION FROM ASSESSED VALUATION
�' �� ! State Fortn d3709 (RS 14-03)
�' P2scn0etl Dy Department af Loral Guvemment Finance
INSTRUCTIONS:
To be 7iled in person or by mail with the County Audiror of the county where the property is locareo. —
Filing Dates: 7) Real Property: Dunng the 12 months before May 11 of the year the deduction is to 6e eHect{v,�,� C �n�
2) Mobile Homes assessed unde� IC 6-7.1-7: Between January 15 and March 2 o/the yea� the'Cl�uctiorQ�s�ro ef(ective.
See reverse side Ior additional instructions and qualifications.
I t, �
Assessed value of real property as of
March 1, current year
.
If no, what is his / her exacl share of interest?
If name on record is different than that
of mortgagee or contract
on reverse
Key number / legal description ewrd number ��
� ) �� � ^ r �� Page number ��� �
(,/ O�I
Mortgage / Contract indebtedness unpaid as o( Is the applicant the soie Iegai or equitable
March 1, current year owner? ❑ Yes ❑ No
�
I( owned with someone other than spouse, indicate with whom.
indicate below:
Address o( mortgagee or contract seller (number and street, cify, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (numberand street,
Does applicant own property in any other
county in Indiana?
20
Signature
approved in the amount of:
20
state, ZIP code)
"--'�-�----`.' I�nn,at.TaxinaDisirid?
1 ;. DrawerNO��„o�,��OV2�
— Card NO . .....................
20 Q� 20 �_ 20
P �
County Auditor
s the property in question:
❑ Real Property p Mobile Home (IC 67.
Has this deduction been requested on
property for current year? � Yes � No
�
Date
20
We certify under the penalty of perjury that Ihe above and foregoing information is irue and wrred and that Ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Address ofauthorized person
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