HomeMy WebLinkAboutMortgage_MathewSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
S� J State Form 63709 (RS / 4-03)
� PresaiDCW by Department of Local Govemment Finance
INSTRUCTIONS:
Coun ""� i1 TownshiD-� H Year
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AR 1 G 2004
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To be �led in erson or b mail wifh the Count Audiror of the coun whe2 the ro e � ✓ � J' l4J '_� �
P Y y ty p p rty is located. _
Filing Dates: 1) Real Property: Dunng the 12 montbs belore May 11 oI the year the deduction is to be effective. �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 75 and March 2 0/ the year fhe deduction is to 6e effective.
See reverse side /or additional instructions and qual�cations.
Applicant (owner or contract bu r- see restric[ions on rev se side)
Taxing Distrid Key number / legal description Record number D�
Q �_ ,y� � / � _O� Page number � /
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Assessed value of real property as of Mortgage / Contred indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diHerent than that of applicant, indicate below: Is the property in question:
� ❑ Real Pmperty ❑ Mobile Home QC G1.1-�
�ame of mortgagee or contract seller ^^
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Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sfreet, ciry, state, ZIP code)
Does applipnt own property in any other If yes, what county? , What Taxing Distrid? Has this deduclion been requested on
county in Indiana? property for current yeaf? � Yes ❑ No
COUNTY AUDITOR
Dedudion approved in the amount of:
zo zo �_ zo �� 20 �� zo 0 9 zo zo
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Signalure County Auditor Date
1/ We rtify under the penalty of perjury that the above and foregoing informalion is true and corred and that the applicants was / were
re ideni of Indiana and owner of the aforementioned property on March 1, 20
qature wners lull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Fu I esident address of applicant Address of authorized person
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