HomeMy WebLinkAboutMortgage_Ravellette�STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
� � FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
w� J Stete Fwm 43709 (R6 / S-06)
Prescribed by Depertment of Local Gwemment Finance �� ��
� � )i._i �.s �t/
INSTRUCTIONS: File ark
To be iled in person or by mail wdh the County Audito� of the county where the p�opeRy is located. AP R 4 Z��
Filing Dates: 1) Real Property: Dunng the 12 months belore June I7 of fhe yea� the deduction is to 6e eflecUve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the ye� fh � d,uct� is to be effective.
See reverse side for additional instruc6ons and qualifications. GIBSON COUNTY AUDITOR
(owne� or contract buye� - see
Taxing District
Assessed value of real property as of
March 1, curtent year
tions on reve�s� side)
IJ
(
Key number / legal description
�-�-��-�ti- �
Mortgage / Contract ii
March 1, current year
Record number
Page number
-oa
edness unpaid as of Is the ap�
awner?
iegai or
� No
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on recorcl is different than that of applicant, indicate below: Is the property in question:
Property 0 Mob� Home pC 61.1-7)
�e of mortgagee or conVact seller �/�
�
Address of mortgagee or contract seller (number and street, city, state, ZIP . .
U�,
Name of assignee or other owner or holder of moRgage •%
P�, \��. f� -.
Address of assignee (numbe� and stieet, city, state, ZIP code) - Q.% . \
. (10 ,�f � .'. �.
Does appliqnt own property in any other Ii yes, what county? Wha�
wunty in Indiana? �3�'�$ ��.
.��¢'p •
COUNTY AUDITOR • \ '•.
)eduction approved in the amount of:
20 �i� 20� 20� 20 20
� � 1
3ignature County Auditor
2U —
Date
-''uction been requested on
-�ent year? ❑ Yes❑ No
.- �
20
I I We certiy under the penalry of perjury that ihe above and foregoing infortnation is W e and cortect and that the appticants was / were
�:sident of Indiana and owner of the aforementioned property on March 1, 20
or by IC 6-1.1-12-.07
person