HomeMy WebLinkAboutMortgage_Gilberte`O2'� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�'M`-' FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
y• State Fwm a3709 (R4110-01) O �
� Prescribcd by DepaM�ent of Loral Govemment Finance p
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INSTRUCTIONS: �� � F�,ileMa�k� �' '
To be filed in psrson or by mail with fhe County Auditor o( the county whe2 the property is located.
Filing Dates: 1) Real Property: During the 12 months be7ore May 11 0l the year the deduction is to be ef7ecti�.E (� � n ZC��
2J Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 of the year the der)uction is to e eHective.
See reverse side /or addrfional instrucfions and quali�cations. n
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Applicant (owner or confract bu r see restrictions on rev e ide)
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Taxing �'strid Key u ber / le � description Record number O/
1 � � _ age number
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owne(? ❑ Yes ❑ No
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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 different than that of applicant, indicate below: is the property in question:
❑ Real PropeAy O Mobile Home (IC 61.1-�
��ne of mortgagee or conlrad seller �\ � ^ �
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Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or olher owner or hoider of mortgage
Address of assignee (numberand street, ciry, state, ZIP code)
Does applicant own property in any other I( yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for wrrent yeaf�(� Yes❑ No
COUNTY AUDITOR
Deduclion approved in the amount of:
20 20 , fl,� 20 jZ� 20 � 20 20 �� 20 Q�
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i ature 0 Q Counry Auditor Date
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� We certify under the penalry of perjury lhat lhe above and foregoing information is true and correct and thal the applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
� ature (o rs full na Person authorized by duly executed Power of Attorney
' or by IC 6-1.1-12-.07
ull residen address of applicant Address of authorized person
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