HomeMy WebLinkAboutMortgage_PetersonSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
t � S�2te Fam 43709 (R4 / 10-07)
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• Prescri0e0 by Department of Local Govemment Finance
INSTRUCTIONS: D E C �il� ��(�
To be filed in person or by mail with the County Auditor oJ the county where the prope�ty is located. /�
Filing Dates: 1) Real PrapeRy: Dunng the 12 months be%re May 11 0/ the year the deduction is to effective. i��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of t t e ctive.
See reverse side (oradditional ins6uctions and qualifrcations. � GIBSON U TY AUDITOR
Applicant (own r qr contrac y r- see restrictions on reverse side)
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Taxing District Key number / legal description Record number O�
A�( /��(aJ (�y��_ �/� /�„ / �O Pagenumber ga
�+ �LJ ---� l-.k-J �1��v (P
A ssed value of real property as of MoRgage / Conirad indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, wrtent year March 1, curtent year owne(? ❑ Yes � No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is difFerent than that of appticant, indicate below: Is the property in question:
❑ Real PropeAy ❑ Mobile Home (IC G1.1-�
�me of mortgagee or contrad seller ��
Address of moRgagee or conVact seller ( mber and street, city, state, ZIP 1/�,� 0� 6�
�/� ' O
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Dces applicant own property in any other If yes, what counry? What Taxing District? Has lhis deduction been requesled on
county in Indiana? property for curtent yeaR � Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �_ 20 20 f� �C 20 O Z 20 �Q� 20 �_ 20
PzA�Bo � P �
Signature County Auditor Date
��/ We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners (ull name) Person authorized by duly executed Power of Attomey
"�.� or by IC 6-1.1-12-.07
F II resident address of applipnt Address of authorized person
.1 I 9 D rA1 y) ba
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