HomeMy WebLinkAboutMortgage_Gray (9)R�" � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
° ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
\ State Fofm a3709 (Ra / 10-07) �
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� PrescribeE by Department of local Govemmeni Finance
INSTRUCTIONS: SEP Fite�pA�02
To be filed in person or by mail wifh the County Audifor o7 the county where the propeRy is located.
Filing Dates: 1) Real P�operty: During the 12 montAs be(oie May 11 of the year the deduction is to 6 flectiv� (/1/ n
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 of th ttra yc` ji '" to bE "efl ive.
See reverse side !or additional instructions and quali�cafions. � G�BSON COU�VT � SUDITOR
Appli o n contract buyer- rest ' ion reverse side)
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T' islrid Key number / legal description R cord number �
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
MarcFi 1, current year March 1, current year ownef? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than lhat of appiicant, indicate below: Is the property in question:
O Real Property ❑ Mobile Home (IC 61.1-n
�me of mortgagee or contrad seiier
Address ot mortgagee or conVacl seller (number and street, city, state, Z ' '
Name of assignee or other owner or holder of mortgage
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Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for wrrent yeaR� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
Zo � zo zo _� 2o L9 Zo �� zo �� zo 0 9
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Signature County Auditor Dale
�'/ We certify under the penalty of perjury that the above and foregoing information is true and corred and thal ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
S' nature (owners full name) Person authorized by duly executed Power of Attomey
OV,��_ or by IC 6-1.1-12-.07
Fuil r ident address of applican Address of authorized person
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