HomeMy WebLinkAboutMortgage_Rispone�� STATEMENTOF MORTGAGE OR CONTRACT INDEBTEDNESS
FQR DEDUCTION FROM ASSESSEO VALUATION Coun Township Year
f�%' Sta;e Form 63709 (RS / 6-03)
�� Prescri�etl by Department of Loral Govemment Finance �
� ��
INSTRUCTIONS:
To 6e filed in person or by mail with the County Audito� ol the county whe�e the property is located. � � T 2 � 26�Mark
Frling Dates: 1) Real Property: Dunng the 12 months 6efore May 11 of the year the deduction is to be e/%ctive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the ye� �the,detl'uctio, is to be eNective.
See 2verse srde for additronal instructions and qualificafions. G�gSON COUNTY AUDISOR
contract
Taxing
on reverse
Key number
number �� �%
��
DO � JGG ��/_ � Pagenumber / �� �/
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Assessed value af real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrtent year March 1, wrrent year owner? ❑ Yes ❑ No
If no, what is his / her exact share of interest?
If owned with someone other than spouse, indicate with whom.
It name on record isdifferent than that of applicanl, indicate below:
' me o( mortgagee or contreU selier
.�� � C�'1 /�
Address of mortgagee or contrad seller (number and stree city, state, Z!P
Name of assignee or other owner or holder of mortgage
of assignee (num6er and sf�eet, city, state, ZIP code)
Does applicant own property in any other I If yes, what county?
county in Indiana?
Deduction approved
20 �
Signature
! " —�
in the amount of:
20 _Q�' 20
/
VVh
❑ Real Property ❑ Mobile Hortie (IC 61.1-�
. � ,
- � _ �75
•
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,�
COUNTY AUDITOR / � �
20 20
County Auditor
E�� p
_ l��
y =quested on
I property for current year?� Yes❑ No
�
20
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and that ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person