HomeMy WebLinkAboutMortgage_Pickersgill�* STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' �= FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
•'-�� � ! State Fwm d3709 (RS / 4-03) _ yi '` u"1 ���Q�{�
P2scn�ed �y DepaRment of loral Governmenl Financa Ii_.j l� � I{"� �j JJ
u � 11 � 1Li'
iNSTRUCTIONS: �File Mark 2003
To be filed in person or by mail with the County Auditor ol the county where the property is located.
Filing Dates: 7J Real Property: During tbe 12 months belore May 11 of the year the deduction is to be eNecfive. (//�
2) Mobile Homes assessed underlC 6-1.1-7: Between January 15 and March 2 of fhe year the,deduction is.lo be'eRect" ive�
See reverse side for additional instructions and qualifications.
� Gi3SON Cvl'�T� ?L�I!�'n 4
contract buxer- see restnctions on rev�fs'� side} ,
number / legal descriplion • Q � Record number
� O � � �� I ^ � ` Page number n [—
O �J
Assessed vaiue of real property as of � Mortgage / ContraG indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year Mamh 1, current year owner? ❑ Yes ❑ No
�
if no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that oi applicani, indicate below: Is the property in question:
❑ Real Property O Mobife Home (IC 67.1-
of mortgagee or contract seller
Address ot mortgagee or contract seller (num6er and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numbe�and sVeet, city, state,
Does applicant own property in any other I If yes, what counry? What Taxing Distrid? Has this deduction been requested on
county in Indiana? propeAy for wrrent year? �J Yes ❑ No
Deduction approved in the amount of:
20
Signalure
20 �_
We certify under the
ysident of Indianaaf
COUNTY AUDITOR
20 .(� I 20 �
Counry Auditor
20 � I 20
Date
�
of perjury that the above and foregoing information is irue and corred and that the applicants was / were
r of the aforementioned propeAy on March 1, 20
Person authorized by duty execuled Pov�er of Attomey
or by IC 6-1.1-72-.07
Address of authorized person