HomeMy WebLinkAboutMortgage_Zetina�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS_ �co shi Year
' FOR DEDUCTION FROM ASSESSED VALUATION 'p( —
�� «� y' Sute Forrt: a37W (R514-03) � � �
PrescriDed by Depertment ol Locai Govemment Finance
iNSiRUCrioNS: �UN 2 9 Z��e Ma�
To be /iled in person or by mail with the County Auditor of the county where the property is located. �1
Filing Dates: 1 J Real Property: During the 12 months before May 11 of the year the deduction is fo 6�,getive�
2) Mo6ile Homes assessed under IC 6-L 1-7: Between January 15 and March 2 of the year tFilded� ��pB be effective.
See reverse side fo� additional instructions and qualifications.
GIBSON COUN� r
Appiicant (ownerorcontracf buyer- e rest ' tions on re erse side)
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Taxing Distrid , Key number / legal description Record numb r
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Page number
3 -oo /- �
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? ❑ Yes ❑ No
a.��
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
� ❑ Real Property ❑ Mobile Home (IC 61.1-�
�me of mortgagee or contract seller ,
Address of mortgagee or contracl seller (number and sfree ity, state, ZIP
Name of assignee or olher owner or holder oi mortgage
Address of assignee (numberand street, city, state, ZIP code)
Does applicarit own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? properfy for wrrent yeaRO Yes❑ No
COUNTY AUDITOR
Deduction approved in fhe amount of:
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P P P
Signature � - - County Auditor Date
�We ceAify under lhe penalty of perjury lhat the above and foregoing intormation is true and corred and thal ihe applicants was / were
resident of Indiana.and owner of the aforementioned property on March t, 20
Signature (own�rs full name � � Person authorized by duly executed Power of Attomey
� � or by IC 6-t.t-12-.07
ull resident address of ipnt Address of authorized person