HomeMy WebLinkAboutMortgage_Bruce�O STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
n"' ' FOR DEDUCTION FROM ASSESSED VALUATION Co 7owns�hi , ear
'e � / State Form a3709 (Ra / 10-01) � [� �
ui.
� Prescdbed by DeDartment of Local Govemmeni Finance M R 0
INSTRUCTIONS: F' e Ma k
To 6e (led in person or by mail with the County Auditor of the county whe2 the property is located.
�'R N OUhTY AJDITOP, .
Filing Dates: 1) Real PropeRy: Dunng the 12 months be%re May 11 0/ the yea� the deduction is to be e/(ech�e. '
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0l the year the deduction is to 6e ef/ective.
See reverse side for additional instructions and qualifications.
Applicant
buyer-
Assessed value oi real properiy as of
March t, current year
on reverse side)
number / legal description � Record
�/L�_ ,1v� �1 /7� ^� Page number � �O
� ��Y7� / d��.J
MoAgage / Con/trect indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curr�nyyear owner? 0 Yes ❑ No
If no, what is his / her exact share of interest? " I( owned with someone other lhan spouse, indicate with whom.
If name on record is different lhan that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home pC 61.1-�
ame of moAgagee or contraIX seller
Address of mortgagee or wnlred seller (number and sf2et, ity, state, ZIP ._ ,., ��
Ad�
Do
�i
20
issignee or other owner or holder of mortgage
-- - r - code)
Drawer NO.O.�:. v.l.D� �unry? What Tauing Distnd?
Card NO . .....................
COUNTY AUDITOR
approved in the amouni of:
�
2� D�� 2� �� 2� �
� P
Counry Auditor
Has this dedudion been requested on
property for wrrent yeaf? [� Yes ❑ No
zo P I zo o�,
P
Date
/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that lhe applicants was / were
� resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name)
�d�nN9ddress of applicant
313 S 2rtcC
Person authorized by duly exewted Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person