HomeMy WebLinkAboutMortgage_Hill (4)�
l
��� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� = FOR DEDUCTION FROM ASSESSED VALUATION
:� w� J Steta Form 63709 (R6/ 5-06)
� Prestribed by Depariment of Local Govemment Fi�nce
INSTRUCTIONS:
Coun Township Year
�° 03
MAY 1 1 �)0�
File a
To be filed in person or by mail wrth the County Auditor of the county where the propeRy is located. —y,,
Filing Dates: 1) Real Property: During the 72 months before June i l o/ the year the deduciion is to be elfACC�-• .��%
2) Mobile Homes assessed under IC 6-1JJ: Between January 15 and March 2 o/the��r��d�iQn����frective.
See reverse side for additronal instiucGons and qual�caGons.
Applicant (ow or contract buyer - s res 'ctions on reverse sid )
� � �Q.
Taxing District Key number / egal description Record number
` lo -/o?-O % -o?U� �G�. �� GU %
��/� ) � Page number ���
���
Assessed value of real property as of Mortgage / ConVact indebtedness unpaid as oi Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? � Yes � No
O 6.�CJ
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate wiih whom.
If name on record is dif(erent than that of applicant, indicate below: Is the properly in quesdon:
❑ Real Property 0 Mob"� Home (IC fr1.1-7)
��ne of mortgagee or contract seller j
//
Address of mortgagee or contract seller (number and stieet, c' state, ZIP
Name of assignee or other owner or holder oi mortpaoe__
Address of assignee (number and street, city, sfah ]� �-;�,}.� �� ,rO ,�/ ,y y / ,- /!� (�/ /
� : �. ..� . r. 7�
Does applipnt own property in any other If yes, � C� �-� 1,rO. ......., las this deduction been requested on
county in Indiana? �2�2G'K� �............ iroperty (or current yeaf? QYesO No
30, OCO. ° �
COUNN AUDITOR
Deduction approved in the amount of:
20 � 20 �_ 20 �� 20 20 20 20
� �
Signature County Auditor Date
I/ We certify under the penalty of perjury that the above and foregoing infortnation is We and cortect and that the applicants was / were
�sident oi Indiana and owner oi the aforementioned property on March 1, 20
..,gnature (owne/s full name) Person authorized by duly executed Power of Attomey
/ or by IC 6-1.1-12-.07
Full resident address of p' � Address of authorized person
.Li