HomeMy WebLinkAboutMortgage_Mason (12)a�'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�i = FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
.,«. /, State Fartn 43709 (R61 SO6) �
� Prescn6ed by Department of Local Govemment Finance -
INSTRUCTIONS: File Maric
To 6e filed in person or by mail with the County Audito� ot the county where the propeRy is located. M/jY � 9 Z��]
Filing Dates: 1) Real Property: Dunng the 12 months 6elore June 17 of the year the deducUon is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the���oryj�be effective.
See reverse side for additional instructions and qualifications.
O� F'
GIBSON COUNTY AUDITOR
� � ,s
Assessed value of real property as of
March 1, wrrent year
no,
name on
exact
of mortgagee or convact
Address oi mortgagee or contract seller
Name of assignee or other owner or
Address of assignee (numberand street
Does applicant own property in any
county in Indiana?
Deduction approved in the amount of:
20 � � 20
P
on reve�se
number /
Record number �Oa n
./
number
A(fJ % �� —
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owner? Q Yes � No
�er and st
mortgage
state, ZIP
someone other ihan spouse, indicate with whom.
;ity - -
�CZri �-�
�t� (/�C9.(lQ�Bf, 300..0
_ � UC�°% _ / cl �l�S
COUN I T Nuvi � v�.
20 �� 20� 20
� � �3
County Auditor
❑ Real
❑ Mobi7e Home pC 61.1-
Has this deduction been requested on
property for wrrent year? ❑ YesO No
�
Date
20
We certify under the penalty of perjury that the above and foregoing information is We and cortect and that the applicants was / were
�sident of Indiana and owner of the aforementioned property on March 1, 20
or by IC 6-1.1-12-.07
resitlent aadress ot appltcant Atldress oi authonzed person - - _ _ _
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