HomeMy WebLinkAboutMortgage_Houchins (5)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
i State Fwm 437W (RS / 4-03)
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/ / Prescnbea Dy Depertment ot Loral Govemment Finance �� � y
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,�tUCTIONS: O C T F�e�ta[�03
To De filed in person or by mail wiih the County Auditor of the county where the property is Ixated.
Filing Dates: 1) Real Property: Dunng the 12 months beiore May 11 01 the yea� the deduction is to be�eRective.
2) Mobile Homes assessed under IC 6•1.1-7: Between January 15 and March 2 o/the � ar the deduction s/to be eflecfi've.
See reverse side for additional instructions and ualifications. /��`����`"`�
9 GIBSON COU� TY AUDITOR
(owner or contract
- see restrictions on reverse side)
Key number / legal de�
Assessed value of real property as of
March 1, curtent year
01�- I �`I'1-<%Ol -
If no, what is his / her exact share o
name on record is
mortgagee or wntract
� ,.., _ ,
that
U l ol ^ (��
Mortgage / Contract ir
March 1, current year
below:
IRecord number
Page number
_ �s�
as of Is the applirant t e sole legal or equitable
owner? s ❑ Na
If owned with someone other than spouse, indicate with whom.
�ss of mortgagee or co frf�i ct seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state,
Does applicant own property in any oiher If yes, what county? I What Taxing Dist
county in Indiana? �
20
Signature
COUNTY AUDITOR
in the amount of:
20 20 20 �� 20 �
\
County Auditor
Is the property in question:
�Real Property ❑ Mobile Home (IC 61.1-7)
���dd
3
''^an requested on
"�s ❑ No
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I/ We certify under the penalty of perjury that the above and foregoing infortnation is true and cortect and that the applicants was / were
a resident of Indiana and owner of the atorementioned property on March t, 20
yty�.i wu yu
�ident addr oi applicant
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Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person
,