HomeMy WebLinkAboutMortgage_Creek/�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
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��FOR DEDUCTION FROM ASSESSED VALUATION ount Year
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Resoihetl by Depariment of Lwal Gwemment Finarxe DE 1 J Z�Ou
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INSTRUCTIONS: �a�le MaQ�
To be filed in person or 6y mail with the CountyAuditor of the county where the property is located. pIBSON COUNTY AUDITOR
Filing Dafes: 1) Real P�operty: Dunng the 12 months 6e%2 ,lune 11 of the year the deduction is to be elfective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to 6e eflecfive.
See reverse side for additional instructions and qualifications.
Applicant (ownero nt t buyer- se restricti on reve e side)
Taxing Dislrid Key number / lega descriplion Record number �
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// � /Y1/ � /y���/ 1y�1 Page number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is ihe applicanl the sole legal or equitable
March 1, current year March 1, current year ownef? ❑ Yes ❑ No
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If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate wilh whom.
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If name on record is different than that of applicant, indicate below: Is lhe property in question:
❑ Real Property ❑ Mobile Hane (IC 61.1-�
me of mortgagee or contrad selier •
Address of mortgagee or contrad seller (number and et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP ca+=�- —
Does applicant own property in any other If yes, what coun D 1'��YCt' � 0... ••••••• �••••••' iction been requested on
counry in Indiana? ,� a,� 7 �rrent year?� Yes� No
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Deduction approved in lhe amount of:
20 O r� 20 �_ 20 �_ 20 20 20 20
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Signature County Auditor Date
�/ We certify under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Sig a re (owners 11 name) Person authorized by duty executed Power of Attomey
� � or by IC 6-7.1-12-.07
F I resident address of applicant Address of authorized person
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