HomeMy WebLinkAboutMortgage_Johnson (42)e`° rt�° E STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i`� FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
S�y S�ate Form a3709 (R4 / 70-07)
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Prescribed by Department of Local Govemment Finance
INSTRUCTIONS: Fj P R F�" �1aZUO2
To be filed in person or by mail with the County Auditor ol the county wheie the property is located.
Filing Dates: 1) Real Propedy: During the 12 months belore May 11 0/ the year the deduction is to be effecfive. //
2) Mobile Homes assessed under IC 6-1.1-7� Between January 15 and March 31 0( the ar the d tion to 6e e ve.
See reverse side Ioraddifional ins6uctions and qualifications. GIBSON COUNT V.4UDITOR
Appli n wr�e� r ontract buyer - see res tipns on reverse )
Taxing District Key number / I al escription Record number
� Page number n �
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Assessed value of real property as of MoRgage / Contract indebtedness unpaid as of Is fhe applicant the sole legal or equitable
March 1, cunent year March 1, current year ownef? ❑ Yes ❑ No
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If no, what is his / her exacl share of interesl? If owned with so one other lhan spouse, indicate wilh whom.
If name on record is different Ihan lhat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
�e of mortgagee or contract seller
Address oi mortgagee or contrad seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand street, ciry, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? propeAy for current year? � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signature County Auditor Date
certify under the penalty of perjury that the above and foregoing infortnation is true and corred and thal the applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
S nature (owner�full name) Person authorized by duly executed Power of Attorney
v V or by IC 6-1.1-12-.07
Ful dent es of ap nt Address of authorized person
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