HomeMy WebLinkAboutMortgage_Firkins�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
State Fwm d3709 (R5 / 4-03) � .
�«•
PrescriDed bj Department ot locai Govemment Finance
INS7RUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county whe�e the property is located. N O V 1 ti 2��4
Filing Dates: i) Real Property: During the 12 months before May 11 0/ the yeai the deduction is to 6e effeclive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year e deductio is e ehe ive
See �everse side for additional instructions and quali�cations.
GIBSON COU TV 4UDITOR
Applicant (owner or contract buyer - see restrictions on reverse side)
• , � .
Taxing Distrid Key number / legal d iption Record number
�/ Page number
- 0�--�U� 'oO
Assessed value of real property as of Mortgage ! Contract indebtedness unpaid as of Is the applicant he sole legal or equitable
March 1, current year March 1, current year ownef? s❑ No
If no, what is his / her exact share of interest? Ii 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-�
e of mortgagee or contract seller
^3
Address of moAgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or olher owner or holder of mortgage
Address of assignee (num6er and streef, city, state, ZIP code)
Daes applicant own property in any other If yes, what county? Drawer N�,,,-, quested on
............... enre
county in Indiana? _ . :ar?0 Yes� No
Card NO. .:Q?�' 7/a�
couNn ' �
Deduction approved in the amount of: �
20 O l0 20 20 ��' 20 �� 20 20 20
�'' P
Signature County Auditor Date
e certify under the penalty of perjury lhat the above and foregoing infortnation is true and correcf and lhat the applicants was / were
esident of Indiana and owner of lhe aforementioned property on March t, 20
Signature (owne/s full nam,�) �� Person authorized by duty exewted Power oi Atlomey
U�� or by IC 6-1.1-12-.07
F I r ' ent addres of ap licant Address of authorized person
�23 ��� 11 � �