HomeMy WebLinkAboutMortgage_Lasley (3)e R� STATEMENT OF MORTGAGE OR CONTRACT INDEI3TEDNESS
- : FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
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.� ���� � Prescrib�d by DeDafimenl of Local GOVemment Finan[e `,
INSTRUCTIONS: ("iQ{� 1��{�
To be filed in person or by mail with fhe County Auditor o/ the county whe�e the property is located.
Filing Dates: 1) Real Property: During the 12 months be/o2 May 11 of the year the deduction is to�effective. � � � n
2) Mobile Homes assessed under IC 6-1J-7: Between January 15 and March 31 of ti{a.�earthe�d�,du�ncislo�8a_effective.
See reverse side /or additional instructions and qualifications. ��' GIBSON C�OUkTY AUDiTOR �
licant ownero nt t uye - e ons on erse side)
ing ' ey numb / e description Record number rl
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D0 �^ a� Page number (�.�C /
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Assessed value of real property as Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, year niJi �O O. owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate wilh whom.
If name on record is different ihan that of applicant, indicate betow: Is the property in question:
❑ Real Property ❑ Mobile Horrie (IC G1.1-�
�me of moRgagee or conlrad seller �
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Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sfreet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
counfy in Indiana? property for wrrent yeaR� Yes❑ No
COUNTY AUDITOR
Deduclion approved in the amouni of:
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Signature County Auditor Date
�/ We certify under lhe penalty of perjury lhal the above and foregoing infortnation is lrue and corred and ihat the applicants was / were
residenl of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ull resident address f applicani Address of authorized person
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