HomeMy WebLinkAboutMortgage_Horrall (2).�;�,
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm a3709 (RS / 4-03)
PresaiEeC by Department of Local Govemment Finance
Coun Township Year
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 monfhs before May 11 0( the year the deduction is to 6e e/%ctive.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction.is totjbe \e\ffective.
See reverse side for addifional instructions and qualifications. �5 �� � p p�
gy
Applicant ( r or contract buyer- see resMctions on erse side) bt Y � 4
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Taxing isirid Keynumber/legaldescription Rec�oyr-d<-,n�u�m-be�J��,,.,�,�c.Y
/� /° Gt3SON COUNTY %-'!`?^'�P �
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curcent year March 1, cunent year 9,��CJ (� ownef? ❑ Yes ❑ No
—`� J � � �'.
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 ihan ihat of applicant, indicate below: Is the properiy in question:
❑ Real Propery ❑ Mobite Home QC 61.1-�
�me of mortgagee or contract seller
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Address of mortgagee or contract selier (number and st t, city, state, ZIP
Name of assignee or other owner or holder of mortgage �
Address of assignee (number and street, city, state, ZIP code)
Does applicant own propeRy in any olher If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current yeaR� YesO No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 �_ 20 � 20
P��-o�a P � P
Signalure County Auditor Date
�/ We certify under the penalty of perjury that the above and foregoing informalion is true and correct and that the applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
I Sign re (owners full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full residenl a dress of ap ' nt Address of authorized person
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