HomeMy WebLinkAboutMortgage_Burkett� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
1 / State Fwm 63709 (RS / 4-03) . . \
�«• rAV�
� PreSCriEed by Department ot Local Gtivemment Finanm �A "\
�\/
INSTRUCTIONS: \\/ File Maric
To be filed in person or by mail with the CounryAUditor of the county where the property is locafed.
Filing Dates: 1) Real Property: During the 12 months be7ore May 1 f o/ the year fhe deduction is to be eHective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be el%ctive.
See 2verse side /or additional instiuctions and quali�cations.
Applicant
Taxing
or contract 6uyer
on
Key number / legal description
�d� �
( /Jn, //^�� � . /}�� � �ie � nO/_ � Page number /D �G
y LL7TS� d"� GJ '/
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or f
March 1, wrr t year March 1, current year ownen ❑ Yes ❑ No
� /�� � av
If no, what is his / her share of interest? If owned with omeone other than spouse, indicate with whom.
�i�ae.e��'�3
- s�
If name on record is diHerent than that of applicant, indicate below: Is lhe p perty in question:
mortgagee or contract seller
Address of mortg eear con�acl seller
v V �
Name of assignee or other owner or hol
and street,
c
(numberand street, city, state, ZIP code)
Does applipnt own property in any other ( If yes, what county?
county in Indiana?
Deduclion approved in fhe amount
��
Signature
20 �
ZIP
��
❑ Real
�
�
❑ Mobile Horrie (IC 61.1-
�
Q...�•_" .....
Dra��'er N �
� ....
I b'l. �....
CardN� 1S3 3�a,
pQ� ha.(.iGnoQ ('J°-n.�
COUNTY AUDITOR
20 I 20 �� 20 �
� �
Counry Auditor
20
Date
20
squested on
] Yes� No
We certify under the penalry of perjury thal the above and foregoing infortnalion is true and wrred and lhat lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
resident address of applicant
ti
Person authorized by duly executed Power of Attomey
or by IC 6-7.1-12-.07
person