HomeMy WebLinkAboutMortgage_Dawson (4) ,a. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County 1 Township I Year 1
;:z.-: i .\ FOR DEDUCTION FROM ASSESSED VALUATION I r
yt % State Form'3709(RI3/tats)
'`•
r.r Prescribed by Department of Local Government Finance I
INS TRUCTIONS:
File Mark
To be Ned in parson or by mail, I Form tyre wit h:
F=iling Dates: :) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is I LI County Auditor
boated on or before January 5 of the immediately succeeding calendar year. I IJ County Recorder
2) Mobile/Manufactured homes not assessed as Real Property Must file wet,the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See re e side for ad{Atonal instructions and oualifl(ot' n
Ao f owner or col`Jn(raf r-see restrictions on reverse
( t
/AV�A' s1 444‘2V17\---)
h - g oistn/' Key numoer l legal oes iption Realm number Pa a number
- IAssessed value d real airway as of Mongeoe/Contract indentedness unpaid as of Morgage/Conirac inoemedness unpaid as of I Is the applicant the sole
assessment oats,os-rent year assessment care.anent year cam of appiobon legal or equitanle owner?
I I� ❑ No
If no vrnat a his!ter exact snare of interest? I If owned with someone other than spouse. with p
If name on record is atfierent than that of aooneant,indicate below. I Is the drape cu • ..:`I0nuaiq
F-/ I Property I I Annually Asses -
Jrt : OC&1
d mongegee p c:send - — -
0
1or d ruaurgagee or onnae surer(n per aria street thy, e,one ZIP code) / / y '�...,ci
. GIBSON Colh(rrV AIIm_.l-rDr
1 Name of assignee o-other owner or holcer of mortgage
I
%.acres of ansigna(nrr,rber aria street thy.sate.and ZIP:me)
Does aop5ant own ptooeny in any II yes,warn=miry? I What Taring asirict? Has this deeuaon been reouesled If yes.sate amount of°ecruefon
other coup on property for
I m Inoiana?ry ]yes ❑No amen',year? I__/t''es L t No I
A person is not entitled to this deduction unless fne person has a balance on the person's mortgage or contact indebtedness that is recorded in the county
r ecorder's office(including any home equity fine of credit that is recorded in the county recorder's office)that is the basis for the deduction.
I COUNTY AUDITOR
IDeoucion amaroved in to amount of:
20 I 20 I 20 I 20 I 20 I 20 I 20
Signature of County Aucito County I Date(month.day,year)
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 Induna and
owner 1 contract buyer of the aforementioned property on dal plication is filed.
pat•re . _r:der nnare , 4 I"'mote(nor may
1 �A L�. �t/l AO ..tt r rls.. �I / / �/, O
IFull resin dent address of mallloans((n�uinoo/err anti ssiaees city.sane, ZIP co`_-I ,y /J,, �{/? ,- n f` 517&7U
Y7( 37 7 // /(J/!/GOLD/ l, / � c,c_F_'!y IW-i — // _
iPerson auraizeo by duly executed Power of Attorney or by C o-t.1 -v.i Date(monm day,yean
I?D r
auess of authoed person (manger and street city stare,and ZIP code) '
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$70,0070.