HomeMy WebLinkAboutMortgage_Stevens (4);i �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�s"' = FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
•v.., .� Stale Fortn 43709 (R6/5-06) . .
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� Presaibed by Depertment of local Gwemment Finance
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�NSrRUCr�oNS: ,1UL 0 3 208ae Ma�
To be (iled in person or 6y mail with the County Auditor of the county whe�e the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months before ,lune 11 of the yea� the deduction is to echv
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 of the�R/���n is to be effective.
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Appli 1(ownerorcontract buyer- se restrictions on rev e side)
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Taxi g District Key number / legal description Record number � ' �
00.7�:
Page number
a�-dv-oa-voy-cx�a3a�-a�3 N�,o .
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, currenl year owner? ❑ Yes ❑ No �
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If no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of appiicant, indicate below: Is the property in question:
❑ Real Property p Mobile Home pC 61.1-�
me of mortgagee or contrad seller
Address of moAgagee or conVad seller (number and street, city, state, ZIP ry 3- U7
lJ.e�� � ��� � 2U� 7—
Name of assignee or other owner or holder of mo ge �%�Q
Address of assignee (number and street, city, state, ZIP code) � Doo a d
w.���5 d �s�
Dces applicant own property in any olher If yes, what county? What Tauing District? Has this dedudion been requested on
county in Indiana? property for currenf year? 0 YesO No
COUNTY AUDITOR
Deduction approved in lhe amounf of:
20 20. 0 20 1 20 20 20 20
P �' ��
Signature County Auditor Date
We certify under lhe penalty of perjury that the above and foregoing information is true and corced and lhat lhe applicants was / were
residenl of Indiana and owner of lhe a orementioned property on March 1, 20
Signature (own s ful m Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
r ident addQress o applican�/t Address of authorized person
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