HomeMy WebLinkAboutMortgage_RussellSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S w/ State Form 63709 (RS I 4-03)
� PresaiDed �y Department of Local Govemment Finaxe
INSTRUCTIONS: � � � � Fil M ic
To be filed in person or by mail witA the County Auditor o/ the county where the propeRy is In cated. � y�� �
Filing Dates: 1) Real Property: During the 12 months be%re May 11 0/ the year the deduction rs to be'eHective. .
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the year,•!he lion is to 6e effective.
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Applicant (ow rorc n ct buyer- s sMctions n reverse sid l�G�gSCN C�OUPli Y��1��T�� �
Taxing 'strid Key number / legal description Record number ��
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Assessed value of rea property as of Mortgage / Contred indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
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If no, whal is his / her ezad share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is diflerent than that of applicant, indicale betow: Is the property in question:
❑ Real Property ❑ Mobile Hane pC 61.1-�
�ame of mortgagee or contraIX seller
Address of mortgagee or contrad seiier (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage D� ��/
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Address of assignee (number and stieet, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing DistriC? Has this dedudion been requested on
county in Indiana? property for current yea(? Q Yes 0 No
COUNTY AUDITOR
Deduction approved in lhe amounf of:
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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
resident of Indiana and owner of the aforementioned property on March 1, 20
Si nature (owners full name) , Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
F II esident addre s of ap icani Address of authorized person
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