HomeMy WebLinkAboutMortgage_Browning (3)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION
�'. � ♦ Siate Fwm 63709 (RS / a-03)
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PtescnDed by Depenment of Local Govemment Finance
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INSTRUCTIONS:
Coun Township Year
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File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located. FEB 0 2 Z��]
Filing Dates: 1J Real Property: During the 12 months 6efore May 11 01 the year the deduction is to be eRective.
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 of the year-tbe deduction is to be effective.
See reverse side for additional instructions and qualifications. �� G`G���
GIBSCN COUNTY qUDITOR
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(owner or
Distrid
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Assessed value of real properfy as
March 1, curtent year
no, what is his / her exact share
number /
Record number
.�I I_ vi/11 _ a� � Page number ��
(il/ lV
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or
March 1 rrent year owneR ❑ Yes ❑ No
�31.aC�� �10�,800
It name on record is different than ihat of applicant, indicate betow:
of moAgagee or conlract seller
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contract seller (number and stieet, city, state, ZIP
Name of assignee or
Address of
owner or holder of mortgage
(number and street, city,
code)
Does applicant -- ---�^�•• �� =��.�rher.l If ves, what counry?
county in Indiai
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What Taxing Districl?
�'�� ���c�� INTY AUDITOR
Deducfion app 355 ��V Ji_O 0� ,��
20 � 20 �_ 20 �_ 2u 20
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Signature Counry Auditor
s the property in question:
� Real Property ❑ Mobile Home QC 61.
Has this dedudion been requested on
propeRy for current yeaR � Yes ❑ No
�
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicanls was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
name)
Person authorized by
or by IC 6-7.1-12-.07
duly executed Power of Attomey
Address of authorized person