HomeMy WebLinkAboutMortgage_Moore (2).� R.,
e E STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i'" . E FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
';��y� Slate Fortn a3709 (Ra I 70.07) �
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PrescribeC Dy Depart�xnt ol Local Govemmem Rnance
INSTRUCTIONS: OCTFi� MaT�p02
To 6e filed in person or by mail with !he County Auditor ol the county where the property is located. ///���
Filing Dates: 1) Real PropeRy: During the 12 months belore May 71 of the year the deduction is to 6e�ctive. �
2J Mobile Nomes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0( the y�e_de�Ie�!"qii is�to ���eiJ@ct ve.
See reverse side /or additional instructions and quali�cations.
GIBSO�� COu^�
�cr o r- see resmcnons on reverse sde)
� iw. � o . (�' � /�
Taxing Distrid U
� W ' '
Assessed value of reai properly as of
March 1, current year
If no, what is his / her exact share of interest?
Key number / legal description
-D34�)-0�
MoRgage / Contract ii
March 1, current year
IRecord number Q �
Page number ^ � �
.�
as of Is the applicant the sole legal or equitable
ownef? ❑ Yes ❑ No
� �.50 O �
If owned with someone other than spouse, indicate with whom.
If name on record is different than lhat of applicant, indicate
of mortgagee or contract seller
Address of mortgagee or contracl seller (number and streef, city, state, ZIP
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 county?
county in Indiana?
Deduction approved in the amount of:
20 � 20 D �
0
Signature
s the property in question:
❑ Real PropeAy ❑ Mobile Home (IC 61.1-�
�
� p3 ,
What Taxing District? Has this deduction been requested on
property for current year? Q Yes ❑ No
COUNTY AUDITOR
20 QS 20 6 �o
V
County Auditor
20 � 20 �_ 20 O q
� 7 1
W�ify under the penalty of perjury that the above and toregoing information is true and corred and that the applicants was / were
�e den of Indiana and owner of the aforementioned property on March 1, 20
E(owners full name)
fent a� of p ilp
OS �p�
Person authurized by duty executed Power of Altorney
or by IC 6-1.1-12-.07
person