HomeMy WebLinkAboutMortgage_HaleSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VAWATION Coun 7ownship Year
` «. / Stale Form 63709 (RS / 4-03) ��p.� � � � d ��
P2scribed try Department of Laal Govemment Finarrce /�
� MAR 0 � 2004
INSTRUCTIONS: File Mark
To be filed in person or by mail wfth the County Auditor o/ the county whe2 the property is located. � �
Filing Dates: 1) Real PropeRy: Dunng the 12 mon[hs be(ore May 11 of the year fhe deduction is fo be.e8ective. �]2�y_
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the'qear_tlie�deductron�is,tmbe;eHective.
See reverse side for additional instructions and qual�cations.
contract buyer - see
Taxing
Assessed value oi real prq¢�erty as of
March t, wrrent year ��
no, what is his / her exad share of inlerest?
on reverse side)
Key number / legal description Record number G
^^ ' �� / 2 (`/ Page number
C..C.J lp �J d
Mortgage / Contrad indebtedness unpaid as of Is the applicant the le legal or equitable
March 1, current year owneR es ❑ No
UD
If owned with someone other than spouse, indicate with whom.
If name on record is different than ihat of applicant, indicate below:
Property ❑ Mobile Home pC &1.
of mortgagee or contrad seller
Address of mortgagee or contrad seller (number and street, city, state, ZIP -
Name of assignee or other owner or holder of mortgage _
Address of assignee (number and street, city, state, ZIP code) Dra wer N —
0..� .�- „(�? a (�
Does applicant own property in any other If yes, what counry? What Ca rd 1V �� ed on
county in Indiana? O . ..................... �❑ No
Deduction approved in the amounf of:
20
Signature
20
COUNTY AUDITOR
20 l )' I 20�
� 1 �
County Auditar
20 �� 20
i
20
/ We ceAity under the penalty of peryury that the above and foregoing information is true and corred and that the applicants was / were
(resident of Indiana and owner of the aforementioned property on March 1, 20
\1 .P , � Q%A
resident addr of applicant
/R.�.\ Box )o� P
K 41 blel�
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person