HomeMy WebLinkAboutMortgage_Herrenbruckl"� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
i� y FOR DEDUCTION FROM ASSESSED VALUATION u ns ' Year
! State Fortn d3709 (R615-O6)
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� Presaibed by Depanment of Laal Gwemmeni Firanca
INSTRUCTIONS: File Mark
To be frled in person or by mail wdh the County Auditor of the county where the propeRy is located. `�ija ,Q�
Frling Dates: 1) Real Property: Dunng the 12 months 6efore June �1 0/ the year the deducGon is to be el%�e. DlT R
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 ot�IB��i��b�c{?�n �sQo be effective.
See reverse side for additional instiuc6ons and qual�ca6ons.
Appli nt (owner or cont2c 6uyer - see trictions on rev e side)
Taxing DisVict Key number / legal description Record number
Page number � �
a�-�a-�sr 30�-�0 0 _o
Assessed vatue of real property as oi Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? � Yes � No
� 9 D6
If no, what is his / her exact share oi interest? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that oi applicant, indicate below: Is the property in question:
Property ❑ Mobile Home QC 6-1.1-7)
�e of mortgagee or convact selier
Address o( mortgagee or contract seller (number and stieet, city, sfate, ZIP
Name of assignee or other owner or holder of moRgage
�7—
Address of assignee (numberand street, city, state, ZlPcode)
Does applicant own property in any olher Ii yes, what caunty? What Taxing District? Has this deduction been requested on
county in Indiana? property for current year? Q YesO No
l� D . _ / COUNTY AUDITOR
-C�r�LJ
DeducGon approved in the a nt of:
20 �Z 20 �� 20 p 20 20 20 20
/ �
Signature County Auditor Date
I/ We certify under the penal[y of perjury that the above and foregoing infortnation is We and correct and that the applicants was / were
sident oi Indiana and owner of the aforementioned property on March 1, 20
a� nature (owne/s full ryme) Person authorized by duly executed Power of Attomey
���/�f� � ��1 or by IC 6-1.1-12-.07
Full resident address/ oi applicantQ Address of authorized person
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