HomeMy WebLinkAboutMortgage_RumbleSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�. w/ State Fwm 63709 (RS / 4-03)
� Prescnbgd by Department of Loral Gdvemment Finance
INSTRUCTIONS:
Coun Township Year
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File Maric
To 6e filed in person or by mail with the CountyAuditor of the counry where the property is /ocated. � � � �, � Z��3
Filing Dates: i) Real Property: Dunng the 12 months be%re May 11 0/ the year the deduction is to be effecfive. �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the,year the deductioniis to be/,effe/c�tive.
See reverse side for additional instructions and qual�cations. �� CI3� \TY�-�-•�`�OR 1
Applicant ner or contract 6 r- see restric 'ons on reverse side)
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Taxing Distrid Key number / legal description Record number
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00 5- o� a i y-� Page number
Assessed value of real property as of Mortgage / ContraU indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, wrrent year March 1, current year _ owneR ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Properly � Mobile Home QC 67.1-�
�ame of mortgagee or contraIX seller , �-+
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Address o( mortgagee or contraIX seller (number a street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st�eet, city, state, ZIP code)
Does applicant own property in any olher If yes, what county? What Taxing Distrid? Has lhis dedudion been requested on
county in Indiana? property for current year?� Yes❑ No
�' 3 3- — a, � COUNTY AUDITOR
Deduction approved in the amount of:
20 20 O 4 20 D` 20 O Y 20 hYl 20 20
T
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Signature County Auditor Date
��/ 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 lhe aforementioned property on March 1, 20
Sig re(owners fu n ) Person authorized by duly execuled Power of Attorney
� or by IC 6-1.1-12-.07
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Full resident addres of applicant Address of authorized person
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