HomeMy WebLinkAboutMortgage_Dawson�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
°. / State Form 63I09 (RS / 4-03)
�«.
� PrestriDed by Department of Loral Govemment Finance
INSTRUCTIONS:
To 6e filed in person or by mail with the County Auditor o/ the county where the property is located. ApR 7 2�0�
Filing Dafes: 1) Real Property� Dunng the 12 months befae May 11 of the year the deduction is to be effeclive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the year the deduction'is to be eNective.
See reverse side for additional instructions and qualifications.
'� GiBSOtJ i.�QUiv i Y Al!DITC': �
ApplicaM (owner or co tract buyer- se sMctions on reverse side) ,
�. . S-a�C, �E.%
Taxing District Key number / legal description • Record number O
(J /„ / /� � , �� — �Q %�� �(J Page number �/�O
/`� Gl�DK \�J �iJ
Assessed value of real property as of Mortgage / Contrad ind�tedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year �� 0 O O ownef? ❑ Yes ❑ No
C1 Od d '
If no, what is his / her exaci share of interest? It owned wilh someone other lhan spouse, indicate with whom.
If name on record is different lhan that of applicant, indicate below: . Is the property in question:
❑ Real PropeAy ❑ Mobile Home (IC 61.1-�
�ame of mortgagee or contract seller -- - --
Address of mortgagee or contract selier (n� e� a�d srreer, � Drawer NO ...................
Name of assignee or olher owner or holder of mortgage Card NO. �/ �� ��O �
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 current yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 �_ zo O Co zo �� 20 ob zo �_ zo zo
-� c� P � P
Signature County Auditor Date
�I/ We certiy under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
i resident of Indiana and owner of the aforementioned property on March 1, 20
Si ature (owners ame Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
F II r sident address o applicant Address of authorized person
" z�K �
------=----------------------------------------