HomeMy WebLinkAboutMortgage_Dyhouse��* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
F FOR DEDUCTION FROM ASSESSED VALUATION u o ship Year
t• w� j State Fwm a3709 (R5/ a-03)
� PrescdOetl by Dapanmem af Local Guvemment Finance
2005
INSTRUCTIONS: File Mark
To be /iled in person or by mail with the CountyAuditor of the cou where the property is located.�f
Filing Dates: 1) Real PropeRy: During the 12 montAS before May 11 of the year the deductio�i �P 6e e�t���
2) Mo6ile Homes assessed under IC 6-7.1-7: Between January 75 and March 2 o�h'�D%a�RHNBb�dqg{Ary�to be effective.
See reverse side for additional instructions and qualifications.
or confract
�
Taxing
Assessed value � real propeAy as of
Maroh 1, wrrent year
no, what is his / her exacl share o( interesl?
side)
Key number�al description
Record number
0�l_
� _� 3 3 �_� Page number
MoRgage / Contrect indebtedness unpaid as of Is the appli t the sole legal or equitable
March 1, wrrent year owner? �es ❑ No
� 00 � �
If owned wifh someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
mortgagee or contract seller
Address of mortgagee or contrad seller (number antVsf�eet, city,
Name of assignee or
Address
owner or holder of mortgage
(numberand street, city, state, ZIP
Does applicant own property in any other ( If yes, what
county in Indiana?
� � Sr �.� ��ox
Deduction approved in the amount of.
20 20Q� 20
�
Signature
�-J
� COUNTY AUDITOR
20 � 20
P
County Auditor
District?
property in question:
� Mobile Hwne (IC 61.
Has this deducfion been requested on
propeAy for current year?� Yes� No
20
Date
20
We certify under the penalty of perjury that lhe above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
S`ig/natuqre (owners/ (ull
X /�4,.-.� �f �,!
Person authorized by duly executed Power ot Attorney
or by IC 6-7.1-12-.07
ofauthorized person