HomeMy WebLinkAboutMortgage_Phillips (5)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
1�� ! State Form 63709 (R5/ a�3)
� P25cribeE by Depanment of Local Govemmeni Finance
INSTRUCTIONS: � ���a�� �
To be filed in person or by maif witA the County Auditor of the county where the property is located. ��
Filing Dates: 1) Real PropeRy: During the 12 months be(o2 May 19 of the year the deduction is to be eHe e.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduc(i�oK is�obe.sf(ective.
See reverse side for additiona nstructions and quali�cations.
M � LUUO
� �- I 3 - I� - �60 � � - 60 lo �_�. .�,�
Applicanl (owner or
Taxing
, � Key number /
Rewrd
COUNTY AUDITOR
1r�u- 0 � 3 — 6�c�7� = �c� .�
Page number
Assessed value of real property as of MoAgage / Contract indebtedness unpaid as of Is the appticant the sole legal or equitable
March t, current year March 1, r,uyey.yqaro O� ownef? ❑ Yes ❑ No
/ �'( /lt
If no, what is his / her exact share of interest?
If name on record is different lhan that of applicant, indicate below:
of mortgagee or contrad seller
Address ot mortgagee or contract seller (number and
of assignee or other owner or holder of mortgage
Clf}�,
Address of assignee (num6er and streef, city, state, ZIP code)
If owned with someone ather than spouse, indicate with whom.
Does applipnt own property in any other If yes, what counry? What Taxing District?
county in Indiana? . -
COUNTY AUDITOR
Deduction approved in-the amount of:
20 _� 20 � � 20
Y
Signature
�
County Auditor
20
�
❑ Mobile Hmie QC Cr1.1-�
Has this dedudion been requesled on
property for current yeaR � Yes ❑ No
�
Date
20
We certify under the penalty of peryury 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
�n e(owners ( a ) � Person authorized by duly executed Power of Attomey
.�,�Q'_ �� �� ,� _ or by IC 6-1.1-12-.07
of authorized person