HomeMy WebLinkAboutMortgage_Hicks (2)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S / State Fortn d3709 (RS / 4-03)
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� Prescnbed by Department of Local Govemment Finarrce
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INSTRUCTIONS: �`� �1 � Fiie Mark �
To be Iiled in person or 6y mail wdh the County Audiror of the county wbere the property is located. �����
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 01 the year fhe deduction is to be eflective.n
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 0! the yegr ti�e �edua��is to be eHective.
See reverse side for additional instructions and qualifications.
Appiicant
Taxing Distrid
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/ legal description
�/9-O�ai�-�
`..:-:ti..�-�f j1-li
Record number
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, current year . owneR �les ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate wilh whom.
If name on record is different than that of applicanl, indicate below:
'ame of mortgagee or contract seller '!/�
�
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (number and street, city, state, ZIP code)
Does appliwnt own property in any other I If yes, what county? What Taxing Distrid?
county in Indiana?
COUNTY AUDITOR
approved in the amount of:
20 A.f I 20� I 20 (�_ I 20
County Auditor
property m questfon:
al Property ❑ Mobile Home QC 61.1-�
Has lhis dedudion been requested on
property for current yea(? � Yes ❑ No
20 �J� 20 _
P
Date
20
1 We ceAify under the penalry of perjury that the above and foregoing information is true and corred and that the applicants was l were
resident of In�ana and owner of the aforementjp{�ed property on March 1, 20
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
address of applicanT l/ IAddress of authorized person