HomeMy WebLinkAboutMortgage_Clark (3)�r�' � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�= FOR DEDUCTION FROM ASSESSED VALUATION
�5,w� / StateFwma3709 (R6I5-OG) �
� Presoibed by Departmem af Lo�al Govemment Finance
INSTRUCTIONS:
Count Township Year
FI E
JUL OF� �
To be rled in person o� by mail with the County Auditor o/ lhe county whe�e the property is located.
Filing Dates: 1) Real Property.� Dunng !he 12 monfhs,before June Il of the year the deduction is to be effe a�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yea� the ded(�U�� be eflective.
GIBSON COUNTY AUDITOR
See reverse side lor additional instnictions and qualircations.
Applicant (owner or co t buyer - see rest ' tio s n rever e side)
Taxing District Key number / legal description Record number ��.
� �_ ,.,^ �, � � Page number � ,iR '
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year ownef? ❑ Yes ❑ No
UvV _ _ -
Ii no, what is his / her exacl share of interest? If owned with someone other than;spouse, indicate with whom. '
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If name on record is different lhan that of applicant, indicale below: Is the property in queslion:
❑ Reai Property ❑ Mobile Home QC 61.1-�
�me of moAgagee or contrad seller . �
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Address of mortgagee or contrad seller (number and st t, city; state, ZIP ' - �
. . _ __-- %
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Name ot assignee or other owner or holder of mortgage _- %
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Address of assignee (number and sheet, cii � �'
� G'.G. �.:..�C..� S'I ;
Dces applicant own property in an other If �� 1���� �� �O . '�
y y � Has this deduction been requested on
county in Indiana? � property for current yea(? 0 Yes ❑ No
�ardN�•;�":�'j��`/3'1�" ',�
(�t'L'�� i Y UA D(ITOR
4
Deduction approved in the amount of:
20 c15 20 � 20 20 20 20 20
P P ►��3
Signature County Auditor Date
' We certify under lhe penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned propeRy on March 1, 20
i nature rs /ull name Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ul esiden address of applicant ' Address of authorized person
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