HomeMy WebLinkAboutMortgage_Warner�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S � Stale Fwm a3709 (RS / 4-03) __�
M� Prescnbed by Department of Loral Govemment Finance T` �� �� ,'
� � {i I� � ��� l� f
�
INSTRUCTIONS: SEP O �,F��€Q'a�
To 6e filed in person or by mail with the CountyAuditor of the county where the property is located. O
Filing Dates: 1) Real Property: During the 12 months before May 11 0l the year the deduction is to be eflective� i � n
2) Mo6ile Homes assessed under IC 6-L 1-7: Between January 75 and Ma�ch 2 0! the year�th'e deduc(ion,is toJtie eHective.
See reverse side for additional insWCtions and quali�cations. ��GjOSO:� CCUt'TY hUDiTG.: �
Applicant (own or t ct buyer- s e ricti on re erse i
Taxing D' 'ct Key number / legal description Record number
�19-03 �Y�o 0
p`Z Page number �
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1,�rrent year owner? ❑ Yes ❑ No
Q��/��r��
L.J liC/[/L/
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diHerent than lhat of applicant, indicate below: Is the property in question:
� Real Pmperty ❑ Mobile Home QC E1.1-�
.�me of mortgagee or contreIX seller
Address of mortgagee or contrad seller (number and street, city, ate, ZIP
Name of assignee or other owner or holder of mortgage �
A
Address of assignee (num6er and st�eet, city, state, ZIP code) O
Does applicant own property in any other if yes, what county? . What Taxing Distrid? Has is deduction been requested on
county in Indiana? property for current year? � Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
20 FTL 20 6"�% 20 �$_ 20 � q 20 20 20
� P P
Signature County Auditor Date
� i We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
.sident of Indiana and owner of the aforementioned property on March 1, 20
i atur (owner ll r�m( ey . Person authorized by duly execuled Power of Aitorney
C'
�, a.��� or by IC 6-1.1-12-.07
en[ address of applicLant Address of authorized person
`�7 .5. /j�2,r/ �% �i^�nCei'c+� ��
76'!�