HomeMy WebLinkAboutMortgage_Gonzalez��n � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
's'�r FOR DEDUCTION FROM ASSESSED VALUATION o 7 s'p vear
��/'• State Fwm a3709 (R6 / 506)
Presaibed by Deperimenl of �onl Govemment Finance
INSTRUCTIONS: �-y� Q ,Eile Mark
To be tiled in person or by mail with the County Auditor o/ lhe county where the property is located. �'I y'�
Filin Dates: 1 Real P�o e Dunn the 12 months before June 17 of the ear the deducGon i U
9 ) P rtY 9 Y �(��� �YFf'Y AUDITOR
2) Mobile Homes assessed under IC 6-1.1-7: Between January 75 and March 2 o Fe yea� the deduc6'on is to be e/fective.
See reverse side for additional instructions and qualifications.
Appliwnt (owner or contract buyer- see restriclions on reverse side)
Taxing Distrid Key number / legal descri tion Record number
�-i.a-dB-/o3-00�0, 98s� a�$ acn
�/ � � � Page number � / �
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, curtent year owneR �f'es ❑ No
�,.��6 ,
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 Property ❑ Mobile Home pC Cr1.1-�
me of mortgagee or contract seller
�3
Address of mortgagee or conVad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sGeet, city, state, ZIP code)
Does appliqnt own property in any other If yes, what county? What Taxing District? Has this deduction been requesled on
county in Indiana? property for current year?� Yes❑ No
� !� / � COUNTY AUDITOR
/L
Deduction approved in the a unt of:
20 �� 20 � 20 �1 � 20 20 20 20
\ �
Signature County Auditor Date
/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that lhe applicants was / were
a resident of Indiana and owner of lhe aforemenlioned property on March 1, 20
Signalure (owners full name) /� Person authorized by duly executed Power of Attomey
k l. ; c � � o� by ic s-i.�-iz-.m
•, : � �-
Full resident address of applicant ��t / Address of authorized person
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