HomeMy WebLinkAboutMortgage_Schlottman (2)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
�• � � J SUte Form A3709 (R5/4-03) �
� PrescriDed by DepaRment of Local Govemment Finance
INSTRUCTIONS: File Mark
To be (led in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: Dudng the 12 months bePore May 11 of the year the deduction is to be e �c �'e
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0) the yearlCf� d�uc on is� ect e.
See reverse side for additional instnictions and qualiFcations. g
Applicant (ownerorcon� .ti yer- see resMctions o v
Tauing Dis n bei
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Assessed value of reat property as of Mortgage /�
MarcF� 1, current year March 1, w
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no, what is his / her exact share of
I( name on record is different than that of applicant,
Record
,��'�{ Q (f -Q � Page numbe
�CJ ! 7'
dred indebtedness unpaid as of Is the a
u,Year.�, ^ r owneR
1 U �1J
below:
MAR 2 i 2006
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t the sole legal or equitable
❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
moRgagee or contrad seller � /�
of mortgagee or contrad seller (number and street, city, state, ZIP
of assignee or other owner or holder of mortgage
Address of assignee (num6er and st�eet, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county. in Ind(ana? �
Deducfion approved in the amount of:
20
Signature
20 Y�R
-p
What Taxing Distrid?
COUNTY AUDITOR
20 ,�`L 20 20
P
County Auditor
Is ihe property in question:
❑ Real Propsty ❑ Mobile Home (IC 6�1.1-�
Has this deduction been requested on
property for wrrent year? Q Yes � No
20
Date
20
We ceAiy under ihe penatty of perjury thal the above and (oregoing information is true and corred and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, ZO
npture (owner's (ull name) n Person authorized by duly executed Power of Attomey
9. ___,.� .,Y t D_� o� bv ic s-,.,-,z-.o�
of authorized person