HomeMy WebLinkAboutMortgage_Schuh (2)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Townshi Year
t J Stale Fortn 43709 (R5 / 6-03) O�
� Preacnb9d 6y DepertmeM of Locel GevBmment Flnence �
��V� DU _ . .
Subject to finai aaeptancz ior trensfer
INSTRUCTIONS: day of File Mark
To 6e filed in person or 6y mail with the CountyAudifor o( the county where the property isTocatett — —
Filing Dates: 1) Real Property During tAe 12 months be%re May 11 01 the year the dedun�y,s to be elJactive.
2J Mobile Homes assessed under IC 6-1.1 J: Behveen January 15 and Ma ��6�e��uctiorfV�tFDbe eflecfive.
See �everse side for additional instructions and qualifications. Gibson County
Percel N
Applicant (owner or contiact b�yer- see restrictions on 2v�e side)
Taxing District Key number / legal description
'`C �3- eG doo -�o •7�3-a� 9
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Assessed value of real property as of MoAgage / Contred indebtedness unpaid as
March 1, wrtent year March 1, curtent year
Itno, what is his / her exaa share of intei
If name on record is difterent than that of
of
or contred seller
below:
Record number h
v
Page number _
Is the applicant he sale legal or equitable
owneR s ❑ No
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owned with someone other than spouse, indicate with whom.
or conVact seller (number and street, aty, state, ZIP
assignee or other owner or holder ot mortgage
of assignee (numberand street, city, stafe, ZIP
property in
❑ Mobile Hane (IC 61.1-�
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for arrent yeaR � Yes � No
COUNTYAUDITOR Dra�vcr \`Q,,,���,,�a�d
DeducUon approved in lhe amouni of: -
zo � I zo
Signature
1� I 20 o't zo I zc
� �
County Auditor
Card NO. .... � � '
:.. ; . .. ............
,
Date
certify under the penalty of perjury that the above and foregoing infortnation is true and corced and that the applicants was / were
ient of Indiana and owner of the aforementioned property on March 1, 20
�l , ,
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applipnt
Person authorized by duty executed Power of
or by IC s-1.1-1z-.o7
authorized person