HomeMy WebLinkAboutMortgage_Kulm� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS �
FOR DEDUCTION FROM ASSESSED VAIUATION ��w+ �T�� Year
�+ 1 State Form a3709 (R5/4-03)
� '" AUG 5 2006
Prescnbetl Dy Depanment ol Local Govemment Finance
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INSTRUCTIONS: �,(G� �e Mark
To be frled in person or by mail with the CountyAuditor of the county whe�e the propeRy is Iocate�IBSON COUNTY AUDITOR
Filing Dates: 1) Real Property: During fhe 12 months before May 11 0/ the year the deduction is to be effective.
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be eHective.
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See reverse side for additional instructions and qualifications.
contract
Taxing Dislrid �
��x��
see
value oi real property as of
MarcFi 1, wrtent year
no, what is his / her exaa share
rce number i iega(,llescription Rewrd number
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O� -(I,� O�p� �q� — (�O , Page number
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Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legat or equitable
March 1, wrrent ye r owner? ❑ Yes ❑ No
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If owned with someone other than spouse, indicale with whom.
If name on record is differeni than thai of applicant, in
�me of mortgagee or contraIX seller �
�
Address of mortgagee or contracl seller (n mber and
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st�eet, city, state, ZIP
below:
city. state,
Does appiiwnl own property in any other I If yes, what county?
wunty in Indiana?
What Taxing District?
COUNTY AUDITOR
Deduction approved in the amount ot:
20 20
� • Drawer NO..°��..�.i.0.�v.:.�.-�a.0 —
Signature Card \O. ...� .................
s the property ir
❑ Real Properry ❑ Mobile Home pC 61.
Has this deduclion been requested on
property for current yeaR� YesO No
Zo
zo
� We certify _..._ ,.,,,,a„y u� per�ury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
ful! name)
Full resident address of applicant
XR�u � �.��._�r.�
Person authorized by duly executed Power of Atlomey
or by IC 6-7.1-12-.07
of authorized person