HomeMy WebLinkAboutMortgage_Seiler (3)�
.,
i«.
�
�
STATEMENT OF MORTGAGE OR CONTRACT INDE
FOR DEDUCTION FROM ASSESSED VALUATION
Stlte Fwm 63709 (RS / 4-03) -
PreSaiEed by Depanment ot Local Govemment Finance
Coun Township Year
�, � '� r '_
�a f — e � � �
� i � -��� �
INSTRUCTIONS: F�I'e7
To be filed in person or by mail with the County Auditor,of the county where the propeRy is located D E � � 6`��
Filing Dates: 1) Real Property: During the 12 months be(ore May 11 of the year the deduction is to 6e effective. �
2J Mobile Homes assessed under IC 6-1.7-7: Between January 15 and March 2 0/ t e year the deduclion is to'b,e eyflective.
�^-^�-�!f �^J ��_�- - - u `i ,
See reverse side !or additional instructions and qualifications. GIBSOtI COU:Ii Y�.uUiiOn
Appli n w er o contrac ye - see restri� ns on ie rse side) '
kc,i� � �x(�>
Taxing Distrid Key n ber / legal descriptio Record number
Yl �/�i/Z2�(ai� O//� �-y�i�� � Page number � S V
LJI--C�"
Assessed value of real property as of Mortgage / Contracl indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owne(? ❑ Yes ❑ No
. — � `�
If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
C�czcG� � �9 0
If name on record is different than lhat of appli nt, indi te below: Is the property in question:
� ❑ Real Property ❑ Mobile Home (IC 61.1-�
" me of moAgagee or contract selle� /� ,
� /1%�
. Address of mortgagee or contract selier (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in any other If yes, what wunty? What Taxing Disirict? Has this deduction been requested on
county in Indiana? property for wrrent yea(?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 /� .f 20 Q!_ 20 �"� 20 20 �g_ 20 20
� P � �
Signature County Auditor Date
•'/ We certify under the penalty of perjury lhaf the above and foregoing infortnation is lrue and corred and that the applicants was / were
resident of Indiana and owner of the aforemenlioned property on MarcFi 1, 20
S�atm�e-(�wners full nande� , Person authorized by duly executed Power of Atlomey
.�� or by IC 6-1.1-12-.07
F II resident address of applicant � Address oT authorized person
7os c- ,.,A",�r F�.BRn.•c..� „� YiLYP