HomeMy WebLinkAboutMortgage_Rumble (2)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
L�«� ! State Fwm a3709 (RS / 4-03)
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Prescribed by Depertment of Locai Govemment Finance y�( � I�
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INSTRUCTIONS:
Mark
To be filed in person or 6y mail with the County Auditor o/ the county where the property is located.� � � 1$ 2°��
Filing Dates: 1J Real Property: During the 12 months be%re May 11 of the year the deduction s to be effective.� n �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be effective.
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See reverse side for additional instructions and qual�cations. .' GI3SON COU� ��� AUDI70ft
(owner or contract t fi}er - see restrictions
Assessed value of real property as of
March 1, curtent year
Ii no, whal is his / her exact share of interest?
'Cey num6er / 1eg21 description
o�s o�i�-�
Mortgage / Contrad indebtedness unpaid as
March 1, wrrent year
If name on record is different than that of applicant, indicate below:
�me of mortgagee or conlrad seller U
/
Address of moRgagee or contract seller (number and stieet, city, s
Name of assignee or other owner or nolder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own propeRy in any other If yes, what county?
county in Indiana?
Deduction approved in the amount of:
20
Signature
Record number
Page number
Is the applicant the sole legal or
ownef? ❑ Yes ❑ No
If owned wilh someone other than spouse, indicate with whom.
ZIP
What Taxing
COUNTY AUDITOR
20 a/� I 20 _�
County Auditar
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s the property in question:
❑ Real Property ❑ Mobile Home (IC 61.
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property for wrrent yeaR � Yes ❑ No
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Date
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
(owners /ull name)
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Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
> of authorized person
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