HomeMy WebLinkAboutMortgage_Stock��� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
z FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
''• � / Siata Fom: <3709 (R5/4-03j
� PrescnDetl by Department of Local Govemmeni Finance
INSTRUCTIONS: File Mark
7o be filed in person or by mail witA the CountyAuditor o! Ihe county where the property is located. �� ���
Filing Dates: 1) Real P�operty: During the 12 months before May 11 of the year the deduction is to be e/fe iv .
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the year t de i t
See reverse side /or additional instrucfions and qualifications.
Appliwnt (owne� or contract
Asbessed value of real property as of
March 1, current year
If no, what is his J her exact share of interest?
If name on record is different than that
of mortgagee or contract
r
on er side)
Key number I legal
6 c3 —oa o�tg- 0 6
APR 1 5 200�-
� GIBSON COUN
Record number /q ^
lJ d�
Page number Q/ L f
Mortgage / ContraG indebtedness unpaid as of I Is the applicant the soie legal or equitable
March 1, current year owner? ❑ Yes ❑ No
� �QO O
indicate below:
I( owned with someone other than spouse, indicate with whom.
Address of mortgagee or contract seller (number and street, city, state,
Name of assignee or other owner or holder of mortgage
Address of assignee (numbe� and street, city, state, Z1P code)
Does applicant own property in any
county in Indiana?
Deduction approved in fhe amount of:
20
SignaWre
20
If
20
what county?
What Taxing District?
COUNTY AUDITOR
20 �_
�
County Auditor
❑ Real
❑ Modle Home (IC 61 J-�
1
Has this deduction been requested on
property for current year?� Yes� No
20� 20
1
Date
20
`/ We certify under the penalty of perjury that the above and foregoing in(ormation is true and corred and lhat the applicanis was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
person