HomeMy WebLinkAboutMortgage_Bottoms (2)j�� t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
s' = FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
� �w� -> State Fam 43709 (R6 / 5-061
� Presaibed by Department of Local Govemment Finance
INSTRUCTIONS: FEB �e��BOE
To be filed in person or by mail with the CountyAudito� of the counfy where the p�operty is located. �
Filing Dafes: 1J Real P�operty: Dunng the 12 months before June Il o( the year the deduction is to be ef/ective� /�
2J Mo6ile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0( the year the �rfTs�e effective.
See �everse side for additional insfiucG�ons and qualifcations. GIBSON COUNTY AUDITOR
Applicant
Distrid
buye�
Assessed value of real property as of
March 1, current year
If no, what is his / her exact share of interest?
on �everse side)
Key number / legal description
-aw-c:u
MoAgage / Contred ir
March 1, currenl year
If name on record is difterent than that of applicant,
of mortgagee or conVact seller
Address ot mortgagee or contract selier (number
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sheet, city, state, ZIP code)
Dces applipnt own property in any othei- "` --�-'--••-�•�
county in Indiana?
Deduction approved in lhe amount of:
zo �� zo
Q P
Signature
Record number o Q
�
Page number n �
Is the applicant the soTe legal or equitable
ownef? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
what.7azino. DisVict?
Drawer NO.. ��O
. ` ...... _ ,
Card NO. .....�.�J..;I, '
�93,�� �.. '
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County Auditor
s lhe property in question:
❑ Real Properry ❑ Mobile Horne pC 61.1-�
Has this dedudion been requested on
property for cuRent year? � Yes 0 No
20
Date
za
certify under lhe penalty of perjury that the above and foregoing infortnation is true and corred and lhat the applicanls was I were
lent of Indiana and owner of ihe aforementioned property on March 1, 20
Person authorized b}
or by IC 6-1.1-12-.07
of authorized person
r�
of