HomeMy WebLinkAboutMortgage_Dyehouse (2)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
4 FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�w� J Siate Fortn d3709 (RS I 4-03)
� - PrescnOetl Dy Depanment o1 Locai Govemment finance �
�INSTRUCTIONS: � � JUL O „F�p�,� .
To be �led in person or by mail with the Counry Auditor of the county where the propeRy is located. � U7
Filing Dates: 4) Real Properry.� Dunng the 12 months 6efo2 May 11 of the year the deduction is ro be eflective.
2) Mobile 1-lomes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the yea�.�d,�y.'�s to be eNective.
See reverse side /or additional instructions and qualifications. GiCSC: ��^:�,yTy qUDITOR
� Applicant (owneror on ct er,- see rgstnctions rev�e side)
�J
Taxing Distrid � � Key number / le description Record number O�
� � � _ � C � Page number ' /
J 7
Assessed value of real property as of MoAgage / ContraG indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, current year owner? ❑ Yes ❑ No
� �D
I( no, what is his ! her exact share of interest? If owned wifh someone other than spouse, indicate with whom.
If name on record is different.ihan lFiat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home QC &1.1-�
�me of mortgagee or contraU seller
Address of mortgagee or contracl seller (number and str , city, stafe, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand streef, city, s[ate, ZIP code)
Does applicant own property in any other. If yes, what county? What Taxing District? Has this deduction been requested on
county in Intliana? � � property for wrrent year? � Yes� No
COUNTY AUDITOR
Deducfion approved in fhe amount of:
20 �_ 20 �_ 20 � 20 20 20 20
P -� P
Signature � � � County Auditor Date
� We certify under the penalty of peryury ihat the above and foregoing information is true and corred and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Si ture (owners fu iame) Person authorized by duly executed Power of Attomey
` or by IC 6-1.1-12-.07
Full resident address of applicant Address of authorized person