HomeMy WebLinkAboutMortgage_McKannan�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�+ / State Fwm 63709 (RS / 4-03) " � �/
w
P25rn�ed by Department of Laal Govemment Finance L
� n�a
INSTRUCTIONS: �UN 1� 2�Flt� Mark
To be filed in person or 6y mail with the CountyAuditor of the county whe2 the property is located.
Filing Dates: 1) Real Property: During the 12 months be%re May 11 0) the year the deductio�� to be ffedtive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Maich 2,bfdhe_yeAr e effective.
See reverse side lor additional inshuctions and qualifications.
/� GIBSO�J COUN�f �
Appucant (o ner or contract bu er- see restrictions on re've'rse side)
C
Taxing Dislrid Key number egal description
���r G/ 3-ooc 3
Assessed value of real property as of MoAgage / Contrad indebtedne:
March 1, current year March 1, current year
If no, what is his / her exact share of interest?
name on rewrd is different than that of applicanj, indicate below:
of mortgagee or contract Selle
. /'.. n � � .l A _
Page
unpaid as of
„�,,,��, o � a �
Is the applicant the sole legal or equitable
ownef? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
of mort§�gee or contrad seller (number and st2et, city, state, ZIP
assignee or other owner or holder of mortgage
of assignee (number and street,
state, ZIP code)
Is
O �
ibya�
� 1����
�,�
61.1-�
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduclion been requested on
county in Indiana? property for current year7 � Yes � No
20
Signature
COUNTY AUDITOR
approved in the amount of:
�/]r'�0�'�
County Auditar
20 �_ zo o � zo
Q P
Date
I/ We certify under the penalty of perjury that the above and foregoing information is true and correct and ihat the applicants was / were
�esident of indiana and owner of the aforementioned property on March 1, 20
Full
Person authorized by duly execuled Power of Attomey
or by IC 6-1.1-12-.07
authorized person