HomeMy WebLinkAboutMortgage_Rogers (4)�
��«.
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION.
Stata Fortn 63709 (R514-03)
PrascriDed Dy DeparirrzM of Lual Govemmeni Finance
Coun Township Year
•�.
wsrRUCnoNS: DEC p�SMar�
To be filed in person or by mail wfth the County Auditor of the county wAere the property is located. � Z�QS
Filing Dates: 1) Real Pioperty: During the 12 months before May 11 of the year the deduction is to be eNective.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year tA�ded�tion,is o be eNecfive.
,cs
See reverse side lor additional instructions and qual�cations.
GIBSON COUNTY AUDITOR
Applicant ( r contract buyer - see stn ' n on reverse side)
Taxing Dis rid Key numb / legal description Record number �
�A_„ Q � �_ � // `� ///� Dj� Pagenumber � (�
t,p�v � ���x'�y �� d
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year \ March 1, currenl year ownef? ❑ Yes ❑ No
4 �
If no, what is his / her exact share of inleresl? If owned with someone other than spouse, indicate wilh whom.
If name on record is different lhan that of applicant, indicate betow: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�me of mortgagee or contract seller
Address of mortgagee or cont�ad seller (number and str t, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st�eet, ciry, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current year?� Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � r 20 �� 20 � 20 20 20 20
� P P
Signature County Auditor Date
/ We certify under the penalty of perjury that the above and foregoing information is true and correct and thal the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
S' nature (owners /ull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.7-12-.07
Full resideni ad ress of a icant Address of authorized person
-��9►� ? d