HomeMy WebLinkAboutMortgage_Dicus"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ = FOR DEDUCTION FROM ASSESSED VALUATION
• State Fam 63709 (R71 / 609)
�' � Presaibetl by Departrtcenl of Lool Govemmenl France
INSTRUCTIONS:
To 6e filed in person a by mail wifh the CounryAUditor or Counry Recorder oI the wunty where the property is located. A� Z Q� Q
FiNrg Dafes: 1 J Real Proparty: Must file durirg the year lor which Na deduction is sought Counry Auditor
2) Mobile / Manufactured Homes rrot assessed as Real Propetly Must file dunng the hveNe (12) months ❑
before March 37 0l each year the deduction is soughc Coun Recwder
See reverse side lor aQ�id��al insVUCtions and quali4s3tiWns. •
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Key number
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r e�tad snara of InteresC!
Cillerent Nan Nat of app6ran4 �7inte 6ebvr.
Nartm af mMgagea a contaU seller
Pdd2a of rtnrtgagee _....._•_..••-u�. i_.�._. _� _.....
Name of assujnee or �
Ooes ePpimntOxn p
counry in Intliaria?
Deduction app'oved in
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I / e certHy rW�
owner I con ct 1
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�6tedness u d as W Mortgage / CoriVx2 iMebtednrs
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I( owned with someo�x other ihan spouse.
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�numDer anE st2ef. ciI}; state, arM ZIP ooa
person (number erN stree( dry, state, and LP aotle)
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appaant Ne sole
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❑ Yes ❑ No
in aurstion: MnuaM AssesseA
¢rtY ❑Afmua�yQssessed
Mas Ihis dedudion
for arrenc yeaY.+
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ry oate (monm, aaY,14a�
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is we and cortect and that Ne appiiqnt is a resident of Indiana antl
oate pnonm. dar.,'�n
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