HomeMy WebLinkAboutMortgage_Blackburn�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
1" • FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
`. � «. /, Sleb Fortn 43709 (R6 ! 5-OG) � g �
A
,� Presaibetl by Department ot Lwal Gwemment Finance �q J
INSTRUCTIONS: ��q`� Z00%
To be filed in person or by mail with the County Auditor of the county whe�e the p�opeRy is locafed.
Filing Dates: 1) Real Property: Du�ng the 12 months before �une �7 of the yea� the deduction is to 6e eflective. �'JJa� ,Q�,
2) Mobile Homes assessed under IC 6-7.7-7: Between January 15 and March 2 0l the year the deduction i�to be e�ctive.
GIBSON COUNTY Al}DITOR
See reverse side /or'additional instn�cUons and qual�cations.
Taxing
(owner
. �
� . .
�yer- see restric�tio,,n.,s _on reveIr�se
W � / �
Key numb�F�llegal description
-il-iY-io�-DO% P8�
Record number
Page number
�a0d
���[�
Assessed value d real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, deren! year March 1, current year p ownef? ❑ Yes ❑ No
' `�.-�� % 8� � O �
I( no, what is hia / her g�cact share
I( name on record fe dBerent than that of applicant, indicate
�me of mortgagea or conVact seller //��
1�
If owned with someone other lhan spouse, indicate with whom.
Addresa ot rtwA�agee a conVact seller (number and street, city, state, ZIP
Name of as4ipne9 a.
Address
owner or holder of mortgage
street, city, state, ZIP code)
Does app6cenf own property in any other I If yes, what county?
county in Indana4
Deducfion apprwed
20
Signature
tn the amount ot:
ZU 20
P
property in queslion:
❑ Real Property ❑ Mobile Horne pC 6�1.1
Dra�ver NOv2�.-„1,,340
Card NO. ..,.,,,
���rsA 3��,,�a.Q�j,,,�;;""
�7� ���.00 �°
What Tauing District? Has lhis deduction been requested on
property for wrtent yeaR � Yes ❑ No
COUNTY AUDITOR
�
County Auditor
20
�
20
We certity under Iha penalty of peryury that the above and foregoing information is true and corred and that the applicants was / were
esident of Indiana and owner of the aforementioned rn�A �on March 1, 20
iture�,a�er�� �
�i �
esident addrass o1 applipnt _
.2 3 o z !�s � l .� 6� -
� �. P,
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person