HomeMy WebLinkAboutMortgage_Terwiske (3).+' `-'�',-'!
ie� A� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
°i. � FOR DEDUCTtON FROM ASSESSED VALUATION , Coun Township Year
/ State Farm 43709 (R6 / 5-06) . . • �
�� Presaibed by Department of Local Govemment Finance
INSTRUCTIONS: NUV 2F�e�
To be /iled in person or by mail with the County Audito� of the county where the property is located.
Filin9 Dates: 1) Real Property: During the 12 months belore ,lune.l7 of the year the deducUon is to be et(ectr,y��
2) Mobile Homes assessed under lC 6-1.7-�: Between January 15 and March 2 of the year th���e��is be elfective.
See �everse side /or additional instructions and qual�cations. GIBSON COUNTY AUDITOR
(owner or contract 6uyer - see
. n
District
Assessed value of real property as of
March 1, curtent year
no, what is his / her exad share of interest?
on reverse
Key number / legal d�scriotion Record number
��� ��� d
Page number
a(�-13-«-lba �oc� l,`�
Mortgage / Contrad i debtedness unqaid as of Is the applipnt the sole legal or equitable
March 1, cunent year ' owneR ❑ No '
, ��b
� If owned with someone other than soouse: indicate wilh whom.
If name on record is different than that of applicant, indicate below:
❑ Mobile Home pC &1.1-�
�e of mortgagee or contred seller
�,.�A�or. �pt7 �'� ' �-- -- -- – —
Address Of mortga e or conVact seiler (number and st2et, city, state, ZIP '. �
Name o1 asaignee or other owner or holder of mortgage
of
st2et, city, state, ZlPcode)
Does appGpnt own property in any other I If yes, what county?
munry in Indiana?
Deduction approved in the amounl of:
20 �
Signature
� `.
/
! ° � �e7
� Dra�r�er\O.`::`.`:`�I":..,:.... —
�
� ..'����. -
�c�o. �a3,sg'f�6�....
What Taxing District? Has this deduction been requested on
property for current year? � Yes� No
COUNTY AUDITOR
20 20 20
County Auditor
20
Date
�
ceAify under the penalty of perjury lhat the above and foregoing information is true and corred and ihat the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by
or by IC 6-1.1-12-.07
resident address of applicanl �Address of authorized person