HomeMy WebLinkAboutMortgage_Bengert� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
's / Stare Form 63709 �R5 / a-03) �
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� P�esaiDeE 6y Department of Local Govemment Finance —
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INSTRUCTIONS: Q P R Fife �M�O4
To be filed in person or 6y mail with the County Auditor of [he county where the propeRy is located.
Filing Dafes: 1) Real Property: Dunng the 12 monfhs 6elore May 11 of the year the deduction is to be�e ective. ��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the.de`duction isLO be e�ective.
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See reverse side for additional instructions and qualifications. �"�°,! �' '^ ..
Applicant (owner or contract buyer- see 2stricti on reverse side) �
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Taxing strid Key nu er / legal description Re rd number
o�in��� 0 3 - 5 �
DG°�1- G/83.5�- �O Page number
Asse ed value of real property as of Mortgage / Contract indebtedness unpaid as of Is lhe applicant t e le legal or equitable
March 1, current year March 1, current year owne(? Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicale with whom.
If name on record is different than Ihat of applicant, indicate below: Is the�Property in question:
�LI Real Property ❑ Mobile Home QC 61.1-�
�ame of mortgagee or contrad s r
Address of mortgagee or contrad seller (number and st city, state, ZIP
Name of assignee or other owner or holder of mortgage '
Address of assignee (number and street, city, sfate, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for wrrent year?� Yes� No
� COUNTY AUDITOR
Deduction appro d in th amounl of:
20 20 O 20 � 20 Q{L 20 .Q� 20 20
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Signature County Auditor Date
��/ We certify under the penalry of perjury that the above and foregoing information is lrue and corred and that the applicants was / were
i resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owner's /ull name Person authorized by duly execuled Power of Attomey
k or by IC 6-1.1-12-.07
Full resident address of applicant ���A� Address of authorized person
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