HomeMy WebLinkAboutMortgage_Keller (2)�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- ' FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
S J State FOrtn 43709 (R4 / 16-01)
�«.
� Presuibed by DepaNnent ot Loca� Govemment Finance
INSTRUCTIONS: � File T rk
To be filed in person or by mail with the County Auditor of the county whe2 the p�operty is located. � � ��
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 0/ the year the deduction is to be eflective.
2) Mobile Homes assessed underlC 6-1.1-7: Behveen January 15 and March 31 of the yeas`fhe d�d� is to be effective.
Snn mvurcu ciiln /nr o.iilffin..ol fo�I..u.N....n �...I....�1;6..oF,.....
_ _ _ _ _ _ __ __ _.__ ._. ___..._.._. ""._..__.._.._ _.._ y__...._...........
� ,�. . �. D
Applicant (owne rc ntract bq � rest 'ction on revers ide �O GIBSON COUNTY AUDITOR �
Taxing Distrid ey umber / legal description Record number ��
� 00� /�^c -� t � �\ Page number �a � f�
IJIJ.� Y— KJ Y
Asse ed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the appliqnt ihe sole legal or equitable
March 1, current year 'March 1, c�rent year ownef? � Yes ❑ No
�Ym
V����
If no, what is his / her exad share of interesl? f owned with someone olher than spouse, indicate wilh whom.
If name on record is different lhan that of applicant, indicate below: Is the property in question:
❑ Real Properiy ❑ Mobile Home QC 61.1-�
�ame of mortgagee or conVact seller ��
Address of mortgagee or conVact seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Dces applipnt own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current yeaRO Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 � 20 f/c 20 �_ 20 �� 20 20
� � � � f' P
Signature County Auditor Date
�'/ We certify under lhe penalty of peryury that the above and foregoing infortnation is true and corred and that lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signat (owners lull name) Person authorized by duly executed Power of Attomey
'•� or by IC 6-1.1-12-.07
Full resideni address of applipnt Address of authorized person
I�R� (joK37 u 7 7 � 9�3
` ---------