HomeMy WebLinkAboutMortgage_DelongSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
♦ ♦ State Fwm 63709 (R5/4-03) �
�' Prestribed by Departrnont of lacal Gtivemment Finance
INSTRUCTIONS:
To 6e filed in person or 6y mail witA the CountyAuditor of the county where the property is located.
Fifing Dates: 1) Real PropeRy: During the 12 months be7ore May 11 01 the year the deduction is to be eRective.��,I Q��0��
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 0/ the year the de �ibn is o e e ective.
See reverse side for addi6onal inshuctions and qualifications. �_
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- sec res�ncuons on
Taxing
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Assessed value ofrealproperry as of
March 1, current year
Ii no, wnat is his / her exad share of interesl?
If name on
Key number / legal description
mll-oo���-r� ��
Mortgage / Contrad indebtedness unpaid as of
March 1, current year
than that o( appiicani, indicate below:
: number n� ^ (
b OC
Is the applicani lhe sole legat or
owneR ❑ Yes ❑ No
I( owned with someone other than spouse, indicate with whom.
!J
mortgagee or contrad seller
Address of mortgagee or contract seller (number and stieet, city, state, ZIP
of assignee or other owner or holder of mortgage
(number and street, city, sfate, ZIP code)
Does applicant own property in any other I If yes, what county? What Taxing Distrid?
counry in Indiana?
COUNTY AUDITOR
Deduction approved in the amount of:
20 !1 20 �_ 20 20 20
P � �
Signature County Auditor
❑ Mobile Hane
Has lhis dedudion been requestetl on
property for current yeaf? 0 Yes� No
20
Date
20
certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
��ow rs (ull name Person authorized by duly executed Power of Attomey
,r __ .� n� n� n_ or by IC 6-1.1-12-.07
address of applicani — ' Address of authorized person
E u� a �26�