HomeMy WebLinkAboutMortgage_McCoy� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun _xx Township Year
� / State Form 63709 (RS / 4-03) � � �
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� PresaiDed by Department of Local Govemment Finance
NO V U 7 20�03
INSTRUCTIONS: /� File Ma
To be filed in person or by mail with the County Auditor of the county whe2 the property is Ixated.//
Filing Dafes: 1) Real P�operty: During the 12 montbs before May 11 of the year the deduction is to�be effectiv���t 1 a 0
2J Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and March 2 of the year�Uie�deducUon is�o�bc�'eHective.
See reverse side for addilional instructions and quali�cations. ��
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Applirant (owner o� contract buyer - see resMctions o reve�se side)
Taxing District Key number / legal descripti Record number
• Page number /�
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant�he sole legal or equitable
March 1, curtent year March 1, current year owner? [y4es ❑ No
1
If no, what is his / her exact share of interest? if owned wiih someone other than spouse, indicate with whom.
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If name on record is different than lhat of applicant, indicate below: Is the roperty in question:
� Property ❑ Mobile Home (IC 61.1-7)
e of mortgagee or contract seller O�_, I c! p D
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Address of mortga e or contract seller (number and streef, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, ciry, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing District? Has this deduction been requested on
counry in Indiana? property for curcent year? ❑ Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signature County Auditor Date
�We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was I were
esident of Indiana and owner of the aforementioned property on March 1, 20
Signature (o s full n e) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Ful resident addres applican Address of authorized person
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