HomeMy WebLinkAboutMortgage_Hicks (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
_�_� FOR DEDUCTION FROM ASSESSED VALUATION •
_r._h`7 State Form 03709(R11/6.09)
�-. " Prescribed by Department of local Government Finance ' .—
File • i
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought ❑ Curl ' 9 4r
2) Mobile/Manufactured Homes not assessed as Real Property Must Me during the twelve(12)months pn
before March 31 of each year the deduction is sought •N4,Pf7E c�o.u.Qnty Recorder
See
ppGCant� or contract buyer instructions and qualifications. GIB U/y C2�-ItJ r Y^%�fi Aunt_
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T. : s• Key /legal description Record number, Page n
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value&real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Matti 1,arrant year Matti 1,=rent year data of application legal or equitable owner?
❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,Indicate with wham
If name on record is different than that of applicant.indicate below: "Donny party in question:Annually Assessed
1 j�j ///(//��il�,�p�`�ear Property ❑Annually Assessed
/Q/ /��(�_ �1 /" / Ce `� Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller %)t/`f/_,�((n C
Address of mortgagee or contract seller(number and street cdy:stag,and ZIP code) /7
Name of assignee or other owner or holder of mortgage
2/4,0 /�/_/ 40 craz/� L
Address of assignee(number and sbee4 city,state,and ZIP code) 1 �(�'G,',(/// s
Dees applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property .
marry in Indiana? n
❑ Yes ❑ No for arrant years ❑ Yes ❑ No •
OUNTY AUDITOR .
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2 „--t M� 20 20 20 20
Signal I4_ 3 ILI 9 Coun (month,Date(m ,day,year)
I/‘ . tu ruregoing information is true and correct and that the applicant is a resident of Indiana and
owner h contract our_. _. dt,.emenlioned property on date application Is filed.
Slgrablre es rue name) Date(month,day,year)
7NFu::),,/resident addrress of� nt(number and street oilyystate,and ZIP code) �p
A &c-%C --0:1�lS��et . 2"T I
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,oily,state,and ZIP coda)