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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNEcc
FOR DEDUCTION FROM ASSESSED VALUATION
Siate Fortn 63709 (R5l 4-03)
Prescribed by Department of Local Govemment Financa
INSTRUCTIONS:
To 6e filed in person or by mail wifh the County Auditor of the county where the property is located., . l !1 �7
Filing Dates: 1) Real Property: During the 12 months be(ore May 11 0/ the year the deduction is ��b� ettecti�6003
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March/2'-p/ the year the deduction is to be eRective.
See reverse side for additional instiuctions and qualifications. �( �%��
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i° GIaSON O�UN7Y AUDITOR
(owner or contract 6�fyb,r - see
Tauing Distrid
Assessed value oi real property
March 1, current year
If no, what is his / her exacl share of interest?
Key number / legal de�cription Record number O 3
�1 / / /1 fi� �3 O Page number
cJ (p �V V a,
Mortgage / Contrad indebtedness unpaid as of Is lhe applip the sole legal or equitabte
March 1, c,µerent year owneR �] �❑ No
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If owned with someone other than spouse, indicate with whom.
name on record is different than that of applicant, indicate below:
of mortgagee or contraIX seller
Address of mortgagee or contrad seller (number and street, city, state, ZIP
or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does appticant own property in any other I If yes, what county? What Ta:
county in Indiana?
Deduction approved in the amount of:
20 �_ 20 �;�
P�Reo� �
Signature
Is the property in question:
❑ Mobile Home pC 61.1-�
:sted on
DrawerNO ................... es❑ No
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COUNTYAUDITO CardN0..1/� :�.1..��
20 � I 20 _p�
County Auditor
z� P I zo o, 20
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We certify under the penalry of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
ent address of applicaTi Address of authorized person
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