HomeMy WebLinkAboutMortgage_Cole (3)^�� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
_ = FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Form C3709 (R11 / 6-W ) �
S � Presaibed by Department of Lxal Govemmem Fnance
Coun Township Year
�VSTRUCTIONS:
fo be filed in person w by mail wdh the CounryAuditor or Counry RecoNer o! the county wAere the property is located.
Filirg Dates: i) Real Pmperty: Must file durirg the year /or which fhe deduclion is sought.
2) Mobile / Manufactured Homes not assessed as Real Property: Must file dunng the (welve (72) months
befae MarcA 31 of each year Ihe deduUion is sought. _
See reverse side jq� addifional inshuctions arM qualilcations.
2Ui1
y Aud'rtor
Ta � isbict � Key nypiC9r / legal d _' _ _ ooO ` 1��' O� Reco Page�
a �o �
AssesseC rehie dmal paperty a d Mortgage / Contraa intlebfeOness unPaid as N Mwtgaga / CmRU3 cbebtetlness �mCaid as of Is Ne eGD�t tlu sok
Ma�di 1. aa�mt year Ma�dy� m year date of appticatim kgal or eQuitade ameR
CX ❑ Yes ❑ No
If no, what is his / her e�mct share of interrst? If ovmeE vrith someone other than spouse. indcate with Mnm
If name m �ecorC's Wfuent Nan ttut of app6rant, uWUate hebw: Is IM property in Question: MnuaOy Assessed
❑ Reai Roperry ❑ Nmually Ass�sed
MoW7e Flortie (IC G1.1-�
Name N mort9�ee or mntrad seller
Address of rtnrtgagee or contrad seDer
or
Dces applifant own property in any oNer
��vy �� i�a��
❑ Yes
numbei and sbee{ cdy, state, aM ZIP code)
er N mortgage
dry, sfate. and ZIP code)
1! yes, what countyt
❑ No
1M�at Ta�drg DistnG7 Has �his deduction Daen requesleE on Dmperty
m� w�� y�r.
❑ Yes ❑ No
COUNTY AUDROR
D�uUOn apprwed in the amount of.
2b 20 _ 2tl 20 20 _ 20 _ 20
Si9naMe ot Camry Auditw Counry Date (monfh, daY. Yea�
I/ We certify uMer Ne penalty of perjury that Ne above aM foregang infortnalion is We and cortect and that the appluant is a resident of Irdiana aM
owner / mntrad buyer of �he aforementionea properry on date applicatlon is filed.
Si9 (owne/s fiAI n e) Date (monlh. daY. ysa�
�.
FWI � nt addr�� of app4ra (num6er anE sfr��t, tlry, state. ZlPaotle) �� O
V
Per'.,on auNOtrzN Oy EWy executetl Power o( AtlomeY a �Y IC 61.1-12-0.7 �� (��h, tlaY• Y��
Pddress of auNomed person (number aM sbee4 �: s!a(e. antl ZIP wde) .