HomeMy WebLinkAboutMortgage_Byrd� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�J Siate Fom: d3709 (RS / 4-03) -
� Prescri�cd by Department of Local Govemment Finance
INSTRUCTIONS:
To be �led in person or by mail with the County Auditor of the county where the property is locateo. --
Fi/ing Dates: 1) Real Property: Dunng the 12 months before May 11 0/ the year the deduction is to be effe�.v o 4,�4g�
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/ the ye,a� the deduction e eflective.
See reverse side for addifional instructions and qualifications.
Applicant(ownerorc n ctbu er-see
Taxing D�rid
�
Assessed value of real property as of
March 1, current year
If no, what is his / her exaci share of interest?
�I830N
Key number / legal description a ` Record n�tnber Q
� _ L � ���D/� Page number � �j �
{/ Q
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
If name on record is different than that of applicant, indicate below:
of mortgagee or contract seller
If owned with someone other than spouse, indicate with whom.
Address of morfgagee or contracl seiler (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (number and street, city, state, ZIP code)
Does applicant own propeRy in any other I If yes, what county? What Taxing District?
county in Indiana?
Deduction approved in the amount of:
20
Signature
20
COUNTY AUDITOR
20 � 20 � 20
P
County Auditor
Is the property in question:
❑ Real Property ❑ Mobile Home pC G1.
Has this deduction been requested on
property for wrrent year?� Yes❑ No
20
Date
20
certify under the penalty of perjury that the above and foregoing information is lrue and corred and that the appiicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
itlent atltlress of applicant Address of authorized person
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