HomeMy WebLinkAboutMortgage_MorrisonSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
µ/ State Form 63709 (RS / 4-03)
PrescnEed by Departmem of local Govemment Finance
Coun Township Year
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INSTRUCTIONS: NOV O % �8�ia�
To be filed in person or by mail with the County Auditor of the counry where the propeRy is located.
Filing Dafes: 1) Real Property: Dunng the 12 months befo2 May 11 0/ the year the deduction is to be-BRecfive�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the y�ar �ed �ipn is to be ef%ctive.
See reverse side for additional instructions and qualifications. G�BSON COUNTY AUDITOR
6uyer-
Distrid
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Assessed value of real property as of
March 1, current year
If no, what is
exact share of interesl?
on reverse
Key number / legal description � Record number
(�_ _ � / � � Q �O Page number � /
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Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneR ❑ Yes � No
S�,lb�,�o _
Ifow^°' -: "—
If name on record is diiferent ihan ihat of applicant, indicate below:
,
�me of mortgagee or contracl seller
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (number and st2et, city, state, ZIP
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Dra��er NO•�
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Card NO . ...............
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ne pC 61.
Does applicant own property in any olher I If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in �ndiana? property for wrrent year? � Yes � No
COUNTY AUDITOR
)eduction approved in the amount of:
20 20 D� 20 20
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Signature
County Auditor
20
20
Date
20
� We certify under the penalty of perjury lhat the above and foregoing information is true and corred and that lhe applicants was / were
a resident of Indiana and owner of the aforementioned properiy on March 1, 20
/ull name)
ss of plipnt
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Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of aulhorized person