HomeMy WebLinkAboutMortgage_Medcalf�w'J
..\c.Z
.F���`
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Form <3709 (R3 / 10-00)
PreSaibeE M State Boartl o1 Taz Commissbnets
InsUuctions for filing:
To be filed in person or by mail with the County AudRor of the county where the property is
located during the 72 months before May 11 of the year the dedudion is to be effective. See
reverse side for additional insVudions and qualfiptions.
FORM 5
Coun Township " Year
:
File Mark
MAY 1 p 2000
GIB�hTY AU�
Applicant (o rorcontract buyer �e �stn 6ons on reverse side) .
('
C�
Taxing Distri Key number / legal desuiption Record number
� � � O� Page number��
�
Assessed value of reat property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year � March 1, curtent year owneR ❑ Yes ❑ No
50
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 d'rfferent than that of applicant, indicate below:
e of mortgagee or contrad seller , ,
Address of mortgagee or contred seller (numbe and street, city, state, Z P
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, dty, state, ZIP code)
Does applipnt own real praperty in any If yes, what county? Whal Taxing DisVid? Has this dedudion been requested on
other county in Indiana? property for current yeaR ❑ Yes❑ No
COUNTY AUDITOR
Deducfion approved in the amount of:
zo p�,g�,�/� zo �_ Zo o zo Q� zo I 20 � Zo ��
7 � � .�
(o'� o y � PTl9 � ° �
Signature County AudRor Date
P
I/ e certify under the penalty of perjury that the above and foregoing information is W e and corred and thal the applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20 �
Sig ature (owners full name) / Person authorized by duly executed Power of Attomey —
�- �� or by IC 61.1-12-.07 '_. -
F I ident address of applican Address of author¢ed person
, Q D Z ri� d