HomeMy WebLinkAboutMortgage_Hurst (8)e`°R�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�+`" : FOR DEDUCTION FROM ASSESSED VALUATION u t o n ip Year
S /. State Form a3709 (R4 / 70.01) �
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PrescribeA Dy DepartneN ot Local Govemment Finance
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INSTRUCTIONS: � Mark
To 6e filed in person or by mail with the County Auditor ol the county whe2 the property is locat�����
Filing Dates: 1) Real P�opeRy: Dunng the 12 months belore May 11 olthe yeart6e deduction is�t �_ t�'e.�rJ7Y :,UDITOR
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ the year�the deduction is to be eHective.
See reverse side (or additional instructions and quali�cations.
or cont2ct buyer - see
Taxing
s(de)
Key number / legal description I Record number AG O a
U
� � _ Page number / �� �
� W
Assessed value of real property as of Mortgage / Contraci indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year ownef? �Yes ❑ No
LI ►�o.�.� ��_
If no, what is his / her exact share of interest?
name on record
of
that ot applicant, indicate
or contrad seller
of mortgagee or wntrad seller (number and street, i
Name of assignee or other owner or holder of mortgage
(numberandst2et, city, state, Z�
Does applicant own property in any other If yes, w'
county in Indiana?
Deduction approved in the amount of:
zo �� zo �_ zo 0
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Signalure 0 9
If owned with
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� �v faxing District?
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COUNTY AUDITOR
20 �� 20
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County Auditor
than spouse, indicate with whom.
P�aPeM
❑ Mobile Home (IC 61.1-�
Has this deduction been requested on
property for current year? � Yes 0 No
2o n 7 zo �
P �
Date
We certify under the penalty of perjury that the above and foregoing information is true and corred and lhat lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
(owners full name)
address of applicant
N. N�f st.
Person authorized by duly executed Power of Atlomey
or by IC 6-1.1-12-.07
of authorized person