HomeMy WebLinkAboutMortgage_Helsley (5)�..,,.,
� � "� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'�' � FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
J Stele Form 63709 (R6 / SO6) ' ' .
� IN� Presaibed Ey Depariment of Local Govemment Finance '�
INSTRUCTIONS: 2 Z�iI�e�Mark
To be filed in person or by mail with the County Auditor ol the county where the property is located. QCT �
Filing Dates: 1) Real Property: During the 12 months 6efore June 11 0/ fhe yea� the deduciion is to be effective.
2) Mobile Homes assessed unde� IC 6-7.1-7: Between January 15 and Ma�ch 2 0l the ye c� is to 6e effective.
�� ��.
See �everse side /or addrtional instroctions and qualifications. G�gSON COUNTY AUDfT�r�
�
�
Applicant (owner nt t uyer - see re
Taxm std
����//���
ri7 (4 � �
Assessed value a( real property as of
March t, current year
If no, what is his ! her exact share of intere
Key number / legal
�_.,r-�
MoRgage / Contrad i�
March 1, current year
If name on record is different ihan thaf of applicant,
moAgagee or contract seller
� v�-a�
iness unpaid �
��� �1
Record number
Page number
of
Is the applicaM the sole legal or
owneR ❑ Yes ❑ No
If owned with someone other lhan spouse, indicate with whom.
of ineAgagee or contrad selier (number and street, aty, state, ZIP
of aeaignee or other owner or holder of mortgage
(numberand sheet, city, state, ZIP
Does applitant own property in any other � If yes, what
county in Indiana7
Deduction approved in
20 �� 20
4.
Signature
the amount of:
0
Taxing Distrid?
COUNTY AUDITOR
20 20 20
County Auditor
Is the propeRy in question:
❑ Real Prop�fy ❑ Mobile Horne pC Gt.
Has lhis dedudion been requested on
property for wnent year? � Yes ❑ No
20
Date
�
We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
lesidenl of Indiana and owner of the aforementioned property on March 1, 20
of
Person authorized by duty executed Power of Attomey
or by IC 6-7.1-12-.07
:'
of authorized person