HomeMy WebLinkAboutMortgage_Hughes (6)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
: ! State Fortn a3709 (RS / 4-03)
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� Presaibed by Department of Local Govemment Finance
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INSTRUCTIONS: f �'"� �� ��F�e Ma�
To be liled in person. or by mail with the County Auditor of the county where the propeRy is located: �'��
Filing Dates: 1) Real Property: During the 12 mon[hs before May 11 0/ the year the deduction is to be ehe �ive� 7 'nn
2J Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0/ the year-t��eductiBrYf��to be effective.
See reverse side for additional instructions and qualifrcations. " � ///��
/ �N'tr
�� . ._..-(�- �
(owner or
Taxing Distrid
see restrictions on �ev�rse side)
Assessed value of real property as of
March 1, currenf year
If no, what is his / her exad share of interest?
Key nurttber / legal �e
�1°l-�
Mortgage / Contrad ir
March 1, current year
If name on record is different ihan that of applicant, indicate below:
�me of mortgagee or contract seller �
Address of mortgagee or contrad seller (number and street,�
Name of assignee or other owner or holder of mortgage
gsl-Do F
edness unpaid as of
number
Is the applicant the sole legal or equitable
owne(? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
Address of assignee (number and street, city, � G V
Does applicant own property in any olher If yi ��� N
county in Indiana? D/_ C�' �/� �
�i !/
Deduction approved in the amount of:
�
Signature
20
�
COUNTY AUDITOR
20 �_ 20 _Q q 20
� �
County Auditar
❑ Real Property ❑ Mobile Home (IC 61.
Has this deduction been requested on
property for wrrent year?� Yes❑ No
�
Date
20
We certify under the penalty of peryury lhat the above and foregoing information is We and corred and that the applicants was / were
�=sident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attorney
or by iC 6-1.1-12-.07
(� ,� A ress of authorized person
Trl..�._ � � L17 L, i C�