HomeMy WebLinkAboutMortgage_RobertsSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S � State Fwm 63709 (RS / 4-03)
� PresaiDed by Departmenf of Local Govemmer,t Finance
INSTRUCTIONS: � � 11 �il Ma
To be filed in person or by mail with the CounryAUditor of the county where the propeRy is 1 ted. �� �'J
Filing Dates: 1 J Real Property: Dunng the 12 months be%re May 11 0/ the year the deduction is to 6e effec,(ive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the yeai thtl ��A�n is to be effective.
See reverse side for additional instrucfions and qualifications.
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Applicant( w rorcontractbuyer-see nctio s ersesid 1° "'" ''
Taxing Dis 'd Key number / legal descnption Record number
O/11/'y._�lG� /1L. Pagenumber �
l b•t� � C.CJ
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole I gal or equitable
March i, current year March 1, current year ' owneR ❑ Yes ❑ No
� vv —
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different ihan that of applicant, indicate below: Is the property in question:
❑ Real PropeAy p Mobile Home (IC &1.1-�
�me of mortgagee or contrad seller
Address of mortgagee or cont�act seller ( u ber and stree city, state, IP c
Name of assignee or other owner or hol e mortgage
Address of assignee (num6er and streef, city, state, ZIP code)
Dces applipnt 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
DeducBon approved in the amount of:
zo 6 za zo 0 9 zo zo Zo zo
P P P
Signature County Auditor Date
� We certity under the penairy of perjury lhat the above and foregoing informalion is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Si ature (ow s/ull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
F I r ent ad s o pplicant Address of authonzed person
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