HomeMy WebLinkAboutMortgage_Gwaltney� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�` J Stata Form d3709 (RS / 4-03)
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PrflsviDeU Dy Depariment of Lonl Govemment Finarxe
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INSTRUCTIONS: - �
To be Fled in person or by mail with the County Auditor o/ the county where the property is located. � p�TY AUDITOR
Filing Dates: 1) Real PropeRy: Dunng the 12 months be%2 May 11 0/ the year the deduction is to t� �Nc��.
2) Mobile Homes assessed under IC 6-1.1J: Between January 15 and Marc6 2 0/ the year the deduction is ro be effective.
See reverse side Ior additional instructions and qualifications.
Applicant
TaxingDistriqf/' .
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Assessed value of real property as of
March 1, wrcent year
It no, what is his ! her exact
interest?
on reverse side)
Key numb�r� legal description
Record number �O� C�
d
o�y- �o �,a� Page number ����
Mortgage / ContraU indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 7, wrrent year owner? ❑ Yes ❑ No
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If owned wiih someone other ihan spouse, indicate with whom.
If name on record is different than ihat of applicant, indicate below:
rne oi mortgagee or contract seller /'�/( , „�
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Address of mortgagee or contred selier (number and street, city, state,
Name of assignee or other owner or holder of mortgage
Address o( as:
Does applicanl �-� /�'� ""'� "�`�
county in India
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Deduction appr• �
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Signature _
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What Taxing Dishid?
AUDITOR
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Is the
❑ Real Property ❑ Mobile Home QC &1.1-�
Has this deduclion been requested on
property for current year?Q Yes❑ No
20
20
� We certify unaer the penalty of perjury that the above and foregoing information is true and correct and that lhe applicants was / were
resident of Intliana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
resident addres5� of applicant� `� n� �Address of authorized person