HomeMy WebLinkAboutMortgage_ButtsSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
+ J State Form 63709 (RS / d-03) �
�«
� PreSCribed by Department of Local Govemmen� Finaxa
INSTRUCTIONS: E� t'� , __
.L' '' �—File�Idaik
To be filed in person or 6y mail with the County Auditor of the counry whe2 the property is located. � 200 L
Filing Dates: 1) Real Property: Dunng the 12 months be%re May 11 0l tbe year the deduction is to 6�fe�feciive. Y
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year tAe deduction is to be effective.
See reverse side for additional instructions and qualifrcafions. � __ � � ��j�
,u-c.�„ _ ..�r _
3!BSCv � : . .t.01T0°
or co�trac�yer - see restricti�s on ieverse side)
i�.�
Taxing bisirid '
���
Assess� real property as of
March 1, wrrent year�
If no, what is his / her exad share of
legal
Record number
O 3 - /o
DO � _ G. / �� � - � Page number
MoRgage / Contrad indebtedness unpaid as of Is the applicant ttie sole legal or equitable
March 1, cunent year owneR �s ❑ No
� % 000 - oz - o - oa/. �� -cb s�
If owned with someone other than spouse, indicate with whom.
If name on record is different lhan that of applicant, indicate
mortgagee or contrad seller
Address of mortgagee or
Name of assignee or other owner or
(number
mortgage
city, state, ZIP
Address of assignee (num6er and st�eet, city, state, ZIP code)
Does applicant own property in any other I If yes, what counry? What T�
county in Indiana?
Deduction approved in the amounf
20
Signalure
20
COUNTY AUDITO
s the perty in question:
�Properly ❑ Mobile Home QC &1.1
_ /V �o �.�
Drawer NO.�•
.•.... ...... ted an
;❑ No
Card NO . .....................
20 �_ 20 �_
Q P
County Auditor
20 _
3
Date
20
We certity under ihe penalty of perjury lhat the above and foregoing intormation is lrue and correct and that Ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 2D
name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
3aaress orappucarn Address ofauthorized person
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