HomeMy WebLinkAboutMortgage_Dehosse (3):� ^,"n\
,ei As STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�•i � FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
L� j+ State Form 63709 (R6 / 5�06)
� Prescnbed by Depanment of Lonl Govemment Finance
INSTRUCTIONS: OCT 1 2 ���p�a�`
To be filed in pe�son or 6y mail with the County Audito� of the county where the propeRy is located.
Filing Dates: 1) Real Property During the 12 months be%re June 11 of the year the deduction is fo be ectrve.
2J Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 o/the ye���is to be effective.
See reverse side for additional inslructions and qualifications. GIBSON COUNTY AUDITOR
contract byyer -
n_. f
K�
on
i o�2
number
- D — _ � ' - �/� Page number ��v�
Assessed value oi real property as of Mortgage / Conlrad indebtedness unpaid as of Is ihe appliwnt the sole legal or equitable
March 1, current year March 1, wrrent year qQ�j� ownef? ❑ Yes ❑ No
If no, what is his / her exact share of interesl? If owned wifh someone other than spouse, indicate with whom.
If name on record is different than that of applicanl, indicate below: Is lhe property in question:
of moAgagee or contract seiler
Address of mortgagee or contrad seller (number and
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sbeet, city, state, ZIP code) :.
Does e E{fO,S $' A
d E ?ROy
county S%AL' y �
Dedu
20
Signature
rar�
nty? � What Taxing Distrid?
O�_ 3ao� COUNTYAUDITOR
20 0 20 20 20
P
County Auditar
❑ Real Property ❑ Modle Hmie OC 61.
property for wrcent
20
20
iested on
Yes O No
We certify under the penalty of perjury 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
Sign ure (owners fu na
� �
Fuil resident ad ess of applicant
� �314�JJ��!
�a��e,.��l
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
authorized person