HomeMy WebLinkAboutMortgage_Lamar (3)STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VAIUATION
�s w� ♦ State Fortn a3709 (R5/4-03) .
P25cnbed by Department of Local Guvemment Finance
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INSTRUCTIONS: � � �
To be �led in person or 6y mail with the CountyAUdito� of the county where the property is located. FEB 1 6 2��6
Filing Dates: 1) Real Property: During fhe 12 months before May 11 0/ the year tire deduction is to be eHective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year thG �d�yeyd�uc[ion is to be effective.
See reverse side for additional instructions and qualifications: �"'� ��
GIBSON COUNTY AUDITOR
Applicant(owne�orcontrectb er see
Taxing Distrid
sA sesse ue of real property as of
March t, current year
If no, what is his / her exact share ot interest?
on
/
number
n/( j n OO /�"O� Page number � �
C/ `I--{J ��
MoAgage / Contracl indebtedness unpaid as of Is lhe applicant the s le legal or equitable
March 1, current year ownef? ❑ Yes ❑ No
�(D c�OO
f owned with someone other than spouse, indicate with whom.
If name on record is different than lhat of applicant, indicate below:
of mortgagee or contracl seller
Address of mortgagee or contrad seller (num�er and street, city,
Name of assignee or olher owner or holder of mortgage
Address ot assignee (numtier and street, city, state, ZIP code)
Does appticant own property in any other I If yes, what county?
county in Indiana?
Dedudion approved in the amount
�
Signature
ZIP
What Taxing Distrid?
COUNTY AUDITOR
20 � I 20 _� I 20 20
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County Auditor
Is the property in queslion:
❑ Real Property ❑ Mobile Home (IC 61.1-�
Has this dedudion been requested on
property for current yeaR 0 Yes � No
�
Date
ceAiy under the penalty of perjury that the above and foregoing information is true and correct and that
ent of Indiana and owner of the aforementioned property on March 1, 20
��(owners full name) Person authorized by duly executed Po�
A I`-., a -...- o� by ic s-�.i-iz-.o�
Address of authorized person
2 c��c,y
20
applicants was / were
Altomey