HomeMy WebLinkAboutMortgage_Lindsey�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-... � FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
♦� f State Fofm a3709 (R4 / 70-07)
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� Prescribed by DepaNreN cf Lmal Govemmeni Finance
INSTRUCTIONS: �� � g .. File�_Mar�c
To be filed in person or by mail with the County Auditor o( the county where the property is 1 ated_ �� Y� q 0.�
Filing Dafes: 1) Real Property: Dunng the 12 months be%re May 11 0/ fhe year the deduction is to be effchve�� �L.�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of th�a�rRhQ dq�cjion is to be e/%ctive.
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Applica t( er or contract 6uyer- see ndions on reverse side) � � r•��� ,-�F
Taxing Distrid ey number / legal description Record ber
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� 1�— O� ' LI O— Gv � Page number G
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrtent year March 1, current year ownef? ❑ Yes � No
3�s�ca
If no, what is his / her exad share of inleresl? If owned with someone other than spouse, indicate with whom.
If name on record is dif(erent fhan that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
�me of mortgagee or conVact seller �/
Address of mortgagee or contrad seller (number and st2et, city, state, ZIP
N /
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing Oistrid? Has this deduclion been requested on
counly in Indiana? property for current yeaR � Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
zo � zo �� Zo �,� 2o O zo �'Z zo �$_ zo 9
i o� • l° %� P � P
Signature County Auditor Dale
��/ We certify under lhe penalty of perjury that the above and foregoing informalion is true and correcl and that the applicants was / were
resideni of Indiana and owner of lhe aforementioned property on March 1, 20
i nature ners lull name) Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
I resident address applipnt Address of authorized person
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