HomeMy WebLinkAboutMortgage_Cieslinskije�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�i'�i; FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�J • State Fwm 43709 (R6 / SO6)
� Presaibed by Depanment of La<al Govemment Finance
INSTRUCTIONS: File Mark
To be /iled in person or by mail with the County Audito� o/ the county where the p�operty is located. �AN � 5 2�08
Filing Dates: 1) Real Property: Dunng the 12 months before ,lune Il of the year the deduction is to be e echve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year thq.�educ�o 6e elfective.
O'��
See �everse side /o� additional instructions and qualifrcations. GIBSON COUNTY AUDITOR
Appli�wnero� cf uy� se sM
Taxing Distrid
/
Assessed value of real property as of
March 1, wrrent year
I( no, what is his / her exacl share of interest?
If name on record is different than that of appl
e of moAgagee or contrad seller
/ ' I ��//OC,d
Address of mortgagee or contract se r(nurty
on reverse
Key number / legal descriplion Record number
a o0
Page number G� �
a�-a 3-ot�- �u i-oc�..59� o
Mortgage / Contrad indebtedness unpaid as of Is lhe appli t ih sole legal or equitable
March 1, current year ownef? Y s ❑ No
/� 35od
If owned with someone other than spouse, indicate with whom.
indicate below:
and street, city, state,
Name of assignee or other owner ar holder of mortgage
Address of assignee (numberand street, city,
Dces apptipnt own property in any other If yes, what county?
counly in Indiana?
�f � � - y-��
Dedudion approved in the amount of:
E'�I���L'f�lZ�i�Fl]
� I P
Signature
Is lhe property in question:
� Mobile Home pC 6-1.1-�
v�-.�„ ��- �o.aGD.7.:.$.�
�/G3 ar'OQ O`�
C:�rcJ NO. . � ;� {�
wr, `�a.t,tqa,� .a .YYlc+o �d/�-�requesled on
� property for cunent year? Q Yes 0 No
� d 7�� NTY AUDITOR
20 20
County Auditor
20
Date
Ti7
certify under the penalty of perjury thal lhe above and foregoing information is true and correct and that ihe applicants was / were
lent of Indiana and owner of the aforementione�Q property on March 1, 20
address of
T
Person authorized by duly exewted Power oi Attomey
or by IC 6-1.1-12-.07
Address of authorized person