HomeMy WebLinkAboutMortgage_Stoll (5)� .
� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
� / State Form 63709 (RS / 4-03)
�M
PrescriDed by Department of Loral Govemment Finance
RUCTIONS:
� oe filed in person or by mail with fhe County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months 6efore May 11 o/the yea� the deduction is to be eHectivei 2� 2U0�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to e eHective.
See reverse side fir additional instructions and quafifications.
Taxing
o� contract buyer - see restrictions on reverse
Key number / legal description
, � Page number
ib - O O � 00 �3
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant, Ft,he` sole legal or equitable
March 1, current year March 1, cunent year owner? �s ❑ No
y
If no, what is his / her exact share of interest? i( owned with someone other than spouse, indicate with whom.
If name on
of mortgagee or contract seller
of mortgagee or contract
assignee or other owner or
applicant, indicate below:
(number and streef, city, state, ZIP
mortgage
and street, ciry, state, ZIP code)
Does applicant own property in any other I If yes, what county?
counry in Indiana?
20
'�
Signature
approved in the amount of:
property
❑ Mobile Home (IC E1.1-7)
--__-- —.. ._a..,,.,,.,, �.e<.,..o..��o�red on
U 3- .7�� � ;oNo
COUNTY AU❑ �� ���
20 �� 20 �_ 20 �
� � P
Counly Auditor
20 �� I 20
P
20
I/ We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was I were
a resident of Indiana and owner of the aforementioned property on March 1, 20
full name)
S. f/o �/✓� L.kJ
�
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person