HomeMy WebLinkAboutMortgage_Heavrin (3)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� ! State Fwm d3709 (RS / 4-03) ' .�� . '
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� Ptescn0ed by Depanment of Local Govemment Finarrce �Q .
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INSTRUCTIONS: � . : File•Mar�ic '
To be �led in person or by mail with the County Auditor of fhe county whe2 the property is located. �'�� �€jJ ��
Filin Dates: 1 Real Pro ert : Dunn the 12 months be(o2 Ma 11 0/ the "
g ) p y g y year the deduction is to 6e efiective.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year�UJe deductippQ�to be eHective.
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�ee reverse sioe ror aomuonai instrucuons ana quamicanons.
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Applicant (owner or c ntracf buyer- see ndio s on re rse side) _ >>5 ' "'""" �"
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Taxing Distrid Key number / legal description Record nu ��_ / i/ i�i
7y b
O/ Q_OO /� o Page number
7 CJ
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicantjhe�sole legal or equitable
March 1, curcent year March 1, currenl year � owneR L`TYes ❑ No
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If no, what is his / her exact share of interest? If owned wilh someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the pr9perty in question:
LFF7eal Property ❑ Mobile Home (IC 6-1.1-�
��ne of mortgagee or contract seiler
Address of moRgagee or contrad seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand st�eef, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current yea(? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 _� 20 �_ 20 � 20 20 20
P � P
Signature County Auditor Date
� We certify under the penalty of perjury thai the above and foregoing intormation is lrue and corred and ihat the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Signalure (owners full name) Person authorized by duly executed Power of Attomey
� ' or by IC 6-1.1-12-.07
ull r ident address ot applicant Address of authorized person