HomeMy WebLinkAboutMortgage_Payne (2).�,. ,
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION C un s'p Year
1 w� / State Form a3709 (RS / a-03)
� PrescnDed by Depariment o( Loral Govemment Finance F B 2 7 2007
INSTRUCTIONS: �a�`�e"Ma�
To be filed in person or by mail with the CountyAuditor of the county where the property is /ocated. GIBSON COUNTY AUDITOR
Filing Dates: 1) Real Property: During the 12 months before May 11 0! the year the deduction is to be eflective.
2J Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 of the year the deduction is to be effective.
See reverse side lor additional instructions and qualifications.
Applicant
buyer- see
Taxing Distri �
Y'i2�-f7/�
Assessed value of real property as of
March 1, currenl year
If no, what is his / her exaa share of interesl?
Dra«�er NO...°.��.��„
�Card NO. ....77.��.........
�o�0�d0U. °�i
reve�se
Key number / legal descriptig(/ Record number
�!o-/A-IS-3oa - ooa ���10 - o� S
0i9 0���� _ (fQ Page number
Mortgage / Contract indebtedness unpaid as of is the appli
March 1, current year owner?
��� �
nt, indicate
�4 v �
7�8 9
t the sole legal or equitable
❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
st2et, crty, state, ZIP
Name of assignee or olher owner or holder of mortgage
Address of assignee (numberand streef, city, state, ZlPcode)
Does applicant own property in any other If yes, what county? What Taxing Distrid?
county in Indiana?
COUNTY AUDITOR
approved in the amounl
20 �_
P
20 O�'
P
20 �_ 20 20
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County Auditor
Is the
❑ Real Property ❑ Mobile Home pC 61.1
Has this dedudion been requested on
property for wrrent year? � Yes 0 No
20
20
We certify under the penalty of perjury that the above and foregoing information is true and correct and that lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 7, 20
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Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person