HomeMy WebLinkAboutMortgage_Austill�,.. ^�n
/���'� 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
s` FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
State Fwm 437W (R6I5�061
� Presaibed by Department of Loral Gwemment Finaixe
To be�il edTIOP Sson or by mail with lhe County Audito� of the county where the property is loca� 1��M�
Filing Dates: i) Real Property: Dunng the 12 months before dune I1 of the year the deduction is to be elfective.
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0/ the ye���; �e�cf�8s to be e/fective.
See reverse side for additional insVuctions and oualiFcations_
� �
Applicant erorconfrdctbuyer-see2 ' 'onsonreversesid GIBSONCOUNTYAUDITOR
Taxing Distrid Key number / Iegal description ' Record number CI
�d
_ 'r �p. �. �j� C_� Page number
'[ 0 O (1J
Assess alue of real property as of Mortgage / Contrad inu�utedness u paid as of Is the applicant the sole legal or equitable
March 1, current year March 1, curtent year owner? ❑ Yes ❑ No
y 50�
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different ihan ihat of applicanl, indicate below: Is lhe property in question:
❑ Real Property O Modle Home (IC fr1.1-�
of moRgagee or contrad seller �
Address of mortgagee or conVad seller (number and street, dty, state, ZIP
Name of assignee or other owner or h�'—� n��'� rs
U
Au,s�1�`���T�
Address of assignee (number and sfn
Does applicant own property in any othe � I z Q ? Has this dedudion been requested on
county in Indiana? ��� (`� �� �� property for wnent yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount ot:
20�_ 20 _Q� 20 20 20 20 20
\ �
Signature County Auditor Date
Ne certify under the penalty of perjury that the above and foregoing infortnation is trve and correct and that the applicants was / were
.,sident of Indiana and owner of the aforementioned property on March t, 20
Signature (own s/ull na Person authorized by duly executed Power of Attomey
`�� ,�� or by IC 6-1.1-12-.07
ull resident address of applicant Address of authorized person
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