HomeMy WebLinkAboutMortgage_Stone (4)`° R�°° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNEgc
-' `:: FOR DEDUCTION FROM ASSESSED VALUATION
c� J�, ,•. J State Form a3709 (Ra / 70-07)
� Prescribe0 by DepaM�ent of Loral Govemment Finance
INSTRUCTIONS:
To 6e filed in person or by mail with the County Auditor o/ the county where the property is
Filing Dates: 1) Real Property: Dudng the 12 months before May 11 of the year the deduction is ��
2) Mobile Homes assessed under IC 61.1-7: Between January 15 and March 31 of
See reverse side /or additional instructions and qualifrcations. �
Applicant
buyer
side)
year the deduction is to be effective.
1' Al"?ITOF
Taxing Distri Key numbef / legal description // Record number ��
(J
6/� ^O/� pO � Page number /�� , !
� �`
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March t, c�eylt year owneR ❑ Yes ❑ No
0!1/ �'% !� ��
If no, what is his / her exacl share of interest? f owned wifh someone other than spouse, indicate wilh whom.
If name on record is different ihan that
�me of mortgagee or contrad seller �',` � ,, /� /y � ,
�/ �J Li /L
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et,
Does applicant own property in any other If yes, what county? What Taxing District?
county in Indiana?
Deduction approved in the amouni of:
�/���i�
rr�eo�
COUNTY AUDITOR
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County Auditor
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❑ Real Property ❑ Mobile Home (IC &1.1
Has this deduclion been requested on
property for wnent yeaR � Yes � No
20 �_
1
20
0
We certify under the penalty of perjury thai the above and toregoing information is true and corred and that the applicanls was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
nalure (owners (ull name) Person authorized by duty executed Power of Attomey
� �� �--- j� �. or by IC 6-1.1-12-.07
of authorized person