HomeMy WebLinkAboutMortgage_Rahman�� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
� = FOR DEDUCTION FROM ASSESSED VALUATION
� ! State Form, d3709 (RS / d-03)
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PrescnDeO by Department of laal Govemment Finance
Coun Township Year
lNSTRUCTIONS: MAY O 3 ��"�Ma�
To be filed in person or by mail with the County Auditor o/ the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months be%re May 11 0! the year the deduction is to baeffective.
2J Mobile Homes assessed unde -1.1-7: Between nuary 15 and March 2 0/ the y�ttaQe,d�"�n is fo be e(fective.
See reverse side /or addifional instructions an q lific ' � GIBSON COUNTy A�p�TOR
la;-�a -
IApplica o �orcont2�uyernsAe tionspnreveseside) / „ � /
Taxing
Assessed value o(re�
March 1, current year
I( no, what is his / her exacl
Key number / legal
Record number
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Page number
as o( Morigage / Contrect indebtedness unpaid as of Is the applicant the sole legal or equitable
March 7, current year owner? ❑ Yes ❑ No
interest?
name on record is different than that of applicant,
of mortgagee or contract seller
o( mortgagee or contract seller (number and
)Q p �
If owned with someone other than spouse, indicate with whom.
below:
city, state, ZIP
Name of assignee or other owner or holder of mortgage� -�
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Address of assignee (numh--"�
Np..P �•:.
Does applicant own � D[a���eY
county in Indiana?
Card�i0• .
Deduction approved in th ..,,,,nr of:
20
Signature
20
G
'hat Taxing District?
COUNTY AUDITOR
20 � 20 �9 20
P P
Couniy Auditor
Is the property in queslion:
❑ Real Pmperty ❑ Mobile Hwne (IC 61.1-�
�
Has this deduction been requested on
property for current year?� Yes� No
20
Date
�
We certify under the penalty of perjury that lhe above and foregoing information is true and corred and that the applicants was / were
resident o( Indiana and owner of the aforementioned property on March 1, 20
it add�kss of applicant
/ / � �X �%� �,v
Person authorized by duly executed Power of Attorney
or by IC 6-7.1-72-.07
f,7G,yo IAddress of authorized person