HomeMy WebLinkAboutMortgage_Dill (2) -. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
b FOR DEDUCTION FROM ASSESSED VALUATION
State form 03709(R11/6-09)
Prescabed by Department of Local Government Finance `
V Fj Mora
INSIRUCTIOHS: AAA J
To be filed in person or by mail with the Court Auditor or Court Recorder of the coup where the
Pe Y County County h property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. r�t1d
2) Mobile/Manufactured Homes not assessed as Real Property Z.,n�ddor
desolation 73c/5--Da/�/ Record number Page^u�mber[)j
Assessed value of real property as of
(0.-11-14'-30 Mortgage O O�4^ I indebtedness unpaid as I Is the app, axle Contract
Match 1,current year Mardi in year 667) date of appGmdon legal or equitable owner?
�V ❑ Yes ❑ No
0 nor,what is his/her exact share of interest? l If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate belovr. Is the property in question:Annually Assessed
❑Real Property ❑AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ✓ 3
Address of mortgagee or contract seller(number and street,coy,state,and ZIP j
Name of assignee or other owner or I
Address of assignee(number and sb
Does applicant own property in any o 1 Y? Has Nis deduction been requested on property
aunty in Indiana? ❑ D1•al\•('I ��0..�•(:-1.•... for current year? ❑ yes Yes ❑ No
Deduction approved in the amount of Card N O. • ..
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforeme property on date application is filed.
Slgpaaye(owns fire name) Date(month,day,Year)
Ful rgside addnad&ess of a . t(number street,city,state,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)