HomeMy WebLinkAboutMortgage_Mabrey'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year ��
�, FOR DEDUCTION FROM ASSESSED VALUATION
� State Form 63709 (R71 / 6-09)
� P�esaibed by Departmertl a( Lo�al Gwemment Fu�ance
�� Fil
INSTRUCTIONS:
To 6e h7ed in person a by mail with the CounryAUditor or Counry RecoNer o! the county whele the property is bcated. F���� 6 20 � �
Filirg Dates: 1) Real Property: Must �de dunig fhe yearlor which tha deduction is soughL County Auditor
2) MobBe / Manufactured Homes irot assessed as Real Property Must file dunng the twelve (72) months I�
6efore MarcA 37 oleach year the deduction rs sought L`t' � �
See reverse side foradtlilionel instructions and qual�cafions. __ ._„_,_,,,,
1 rdue of mal p�openy as of
anenl yrar
no. whal Is ttis I hu nxap 5hare Of Nteresl?
�me m remtl is ddfe�mrt than that N aod
�ei i aesrnp O O ' � �1 � • . / n �_ �� � V /V Pa9e nvmbrl
�V V �T 0 (O
ge / Contrac['udehteEr�s unpaiE as W Mortgage / ConVa[Y'uWebteMess unpaiE az of Is Ne app6rant the sde
1, artent year Eate of appfiption 1eg21 a eQUitade owneP
/ ❑ Yes ❑ No
If wmeC vrith someone aher than spouse, Micata with wlmm
ant. uWifate bebw. Is WoPeRY in puesoon: Mnua%' Assesse0
Real Property Q AnnualyASSessed
Name oi nqrtgagee a mntract seller/� ,{'�/
� ���
Pdd2ss of mortgagee w wntraq seAer (num6er and 50
Name of assignea w other owner or hdder ot �mrtgage
ADCress ot ae�nea (num6eiaM stree4 d�: s7ate, antl
Dces applifant wm pmperty in any oNu
munry in InEa`u?
❑ Yes ❑ No
Deduction appraved in Ihe amount af.
20 20
Si9nature ot CotmN Audi�or
certify under the penalry of pi
own / contracl quYe� 4f U�e a�om�l
aM ZIP code)
�f �. �� ���
COUNTYAUDROR
�
�Oid ...
]�t'�1�'Ci \� ....:...........
5?�7.....
Card NO . ............ �
�18�0�.'
20 20 20 - 20 20
Counry Date (monN. daY yea�
the above a�W foregoing infortnatlon is We and mrtec[ a`M that the applinnt is a resident of I�iana arM
property on date applicalion is filed.
. � Date (monfi, daY. Yaa�
�YY��
Address W eutha'¢ed persnn (num0ar and stree4 �'79! sbte, and LP mEe)