HomeMy WebLinkAboutMortgage_Parks� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION n 'sh Year
� J State Form a3709 (RS / a-03) � -
� «•
P2soiEe,y py Departmen; of Loral Gtivemment Finance J UN 2 9 2006
INSTRUCTIONS: ��µ ���
To be filed in person or by mail with the County Auditor of the county where the property is located Q �
Filing Dates: 1) Real Property: During the 12 months 6efore May 11 otthe yearthe deduction is to�d����cFrve.UNTY AUDITOR
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be eflective.
See reverse side lor additional instructions and qual'fiications.
see
�
Assessed value of real property as of
March 1, curtent year
If ,io, what is his / her exact
of mortgagee or
ofinterest?
of
of mortgagee or contract seller
reverse side)
Key number / legal descri tion Record number
�!,-/a- �•30�-�' a8a/-o�.8 '.��
�/�_ ��� / � Page number
��a/
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current ye�i owner? ❑ Yes ❑ No
below:
and street, ciry, state. ZIP
Name of assignee or other owner or holder of moRgage
of assignee (number and stieet city, state. ZIP code)
with someone other than spouse, indicate with whom.
Does applicant own propeRy in any olher I If �.P_., What coun �
. b � What Taxir
county in Indiana?
COUNTY AUDITOR
)eduction approved in the amount of:
20Q� 20�_ T20 09 20
Q I -P � , ;
Signature
County Auditor
�
❑ Real Properfy ❑ Mobile Home (IC 61.1-�
Dra���er NO:::.�'�..��!......
` 3535
Card NO . .....................
'�,,n,� �'��.,k�Q,.,.��.
20
Date
20
�d on
❑ No
We cenify under the penalty of peryury that the above and foregoing infortnat�on is We and corred and ihat the applicants was / were
'=` i,. resident of Indiana and owner of the aforementioned property on March 1, 20
nama)
address
Person authnrized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person