HomeMy WebLinkAboutMortgage_BaldwinSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
S � Stafi Form 63709 (RS / 4-03) �
��� PtesaiDed by DepaNrc:it cf Lml Govamment Financa
INSTRUCTIONS:
Coun Township Year
I ED
JAN 1 �;�4,Q�,�
To be filed in person or 6y mail with the CountyAuditor of the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months be%re May 11 0l the year the deduction is to 6e e�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the yeaf the�c�u�o s to be el%ctive.
See 2verse side for additional instructions and qual�cations. OIBSON COUNTY AUDITOR
Appiiwnt (oimerorcontract yer- see restriclion on reverse side)
Taxing istrid Key number / legal description Record number �
��,p�� � I � � ' � �y � � Page number
l..(/ � ' /
Assessed value of real property as of Mortgage / Contrect indebtedness unpaid as of Is the applicant the sole legal or equitable
March i, curtent year March 1, wrrent year ownef? ❑ Yes � No
8�,�
If no, what is his / her exact share of interest? If owned wilh someone other than spouse, indicate with whom.
If name on record is different than that of applican indicate bel Is the property in question:
' ❑ Real Properly ❑ Mobile Home (IC &1.1-�
;"�me of mortgagee or contrad seller
Address of mortgagee or cont2cl seller (number and street, city, state, ZIP
, . 00 - '7 S
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st�eet, city, state, ZIP code)
Does applicant 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
Deduction approved in the amounl of:
20 � 20 _(�_ 20 � 20 20 20 20
� -P P
Signature Counry Auditor Date
We certify under lhe 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
a re (owners full name) Person authorized by duly executed Power ot Attorney
I or by IC 6-1.1-12-.07
F resident addre s of �pplipnt Address of authorized person
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