HomeMy WebLinkAboutMortgage_Westerfield�
� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION C Tow Year
�'. «. ! State Form 63709 (R5 / 4-03)
�� PrescoDed by Department oF Local Gdvemment Finance �
INSTRUCTIONS: � F;ip��
To 6e filed in person or by mail with the County Auditor of the county where the property is located. e�
C/
Filing Dates: 1) Real Property: During the 12 months belore May 11 0/ the year the deduction is to be @1@80M. COUNTY AUDITOR
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be effective.
See reverse side tor additional instructions and quali�cations.
Applicant
Tauing
s
buyer - see resti
��� �
Assessed value of real property as of
March 1, current year
Ii no, whal is his / her exad
interest?
side)
e
Key number7legal descnption ecord number
�/9� ��� �� �d Page number
Mortgage / Contraci indebte ness unpaid as of Is the applii
March 1, current yearQ owne(?
1 the sole legal or equitable
❑ Yes 0 No
If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicafe be�ow:
�e oi moRgagee or contract seiler ,
�Ll� �� �—
Address of mortgagee or contract selier (numbe and stieet, city, state, ZIP
Name of assignee or
'�, holder of moAgage
��
s
street, c�, st�te, ZIF
Does applicant own property in any other
county in Indiana?
Deduction approved in fhe amount �f_
What Taxing District?
I .
COUNTY AUDITOR
.O Real Property ❑ Mobile Hwr�e QC 61.1-�
Has this dedudion been requested on
property for current year? � Yes � No
zo �_ zo �_ Dra n,er — zo zo
9 N°' °'�-�'`-���/
Signature Card 1V�. � Date
�We certify under the penalt} __, �' ; irue and corred and that the applicants was / were
sident of Indiana and owner of the aforemen��,,,.__ , _
Signature o a!J-a� I Persoi� o.....orized by duly executed Power of Attorney
' or by IC 6-1.1-12-.07
applicant Address of authorized person
TNSr � ��rr� .�,✓. ���o