HomeMy WebLinkAboutMortgage_WoolemsSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
S / State Fortn 63709 (RS / 4-03)
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� Prescri�ed by Department ol Lasl Ctivemment Finance
INSTRUCTIONS:
Coun Township Year
File Maric
To 6e filed in person or by mail with the CountyAuditor of the counry where the property is loc� ����
Filing Dates: 1) Real PropeRy: During the 12 months before May 11 0/ the year the deduction i e He ive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Maich 2 of e ye t d d tion � to e eflective.
See reverse side for additional instructions and qual�cations.
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Applicant (owneror t�a t buyer- see rest ''o n verse side) °��
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Taxing Distrid Key number / legai descnption R cor number O�
�O _ Page number � / O
Assessed value of real pro rty as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year ownefl ❑ Yes ❑ No
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If ,io, what is his / her exact share ot interest? If owned with someone other lhan spouse, indicate with whom.
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If name on recard is difterent than lhat of appticant, indicate below: Is lhe property in question:
❑ Real Property ❑ Mobile Horrie (IC 61.1-�
me of mortgagee or contraG seller
Address of mortgagee or wntract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for current year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amounf of:
20 �� 20 �� 20 �_ 20 20 20 20
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Signature County Auditor Date
'' We certify under the penalty of perjury ihat the above and foregoing infortnation is true and correcl and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
Full resident address of applicanl Address of authorized person