HomeMy WebLinkAboutMortgage_HaireSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�. w� / State Form a3709 (RS / 4-03) � �
PresaiDed hy Department of Local Gtivemment Finaxe j �
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J1 Y .K.s
INSTRUCTIONS: F� B O 3?OO'Y ile Mark
To be filed in person or 6y mail with the County Auditor ol the county where the property is locale .
Filing Dates: 1) Real Properry: Dunng the 12 months be%re May 11 0/ the year the deductlon is to be effecGve. � ��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Mar�� 2 of ^t6�e-�y�ar�h`e.d�uc` �n is,to be eNective.
See reverse side for additional instructions and qualifications. � G/ IBSO�'J COlni r r,uD�TOR 1
`,l!`�`�-�"i<Z(�C /
Assessed value of real property as of
March 1, current year
If no, what is his / her exad share of interest?
name on record is dif(eren[ than that of
of mortgagee or contract selier
Address of mortgagee or conUad seller
on reverse
Key number / legal description Record number a� �
(J
� j� � `Y f�.� Page number
(�[J4 Q
MoAgage / Contract indebtedness unpaid as of Is lhe applicanf the sole legal or equitable
March 1, current year � owneR ❑ Yes ❑ No
owned with someone other than spouse, indicate with whom.
below:
and street, city, state, ZIP
assignee or other owner or holder of mortgage
of assignee (number and st�eet, city, state,
Does applicant own property in any olher I If yes, what county? I What Taxing District?,
county in Indiana?
20
Signature
approved in the amount of:
20
COUNTY AUDITOR
20 0 20 O g 20
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County Audilor
Is the property in
❑ Real PropeAy ❑ Mobile Hortre pC 61.
20
Date
d�duction been requested on
for current yeaR � Yes ❑ No
20
/ We certify under the penalry of perjury that the above and foregoing information is true and correct and lhat the applicants was / were
`-esident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized b�
or by IC 6-1.1-12-.07
Full res�enl addr�s� of applicant � 1 � � yJ�j f IAddress of authorized person
Attomey