HomeMy WebLinkAboutMortgage_Retter (2)�ei '"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`i•�; FOR DEDUCTION FROM ASSESSED VALUATION Count 7ownship Year
,�
�j State Farm 43709 (R6 / 5-06) " . . .
� Presaibed by OeparUnenl of Local Gwemment Finance
INSTRUCTIONS: r'ile Mark
To be filed in person o� by mail wfth the County Auditor o/ the county where the property is located. Q� � Q 3 2���
Filing Dates: 7) Real Property: Dunng the 12 months be%re ,lune �l o/the yea� lhe deduclion is to be eBective.
2) Mobile Homes assessed under IC 6-L 1-7: Between January 15 and Maroh 2 of fhe year the d��tion is tp�effecfive.
O��ay ,�S
See �everse side for additional instructions and qualifrcations. �/
GIBSON COUNTY AUDITOR
Applicant (owne� or contract
Taxing Dislrid
1 � IM:� fu
Assessed value of real
Mazch 1, current year
�er - see re
�
�
as of
I( no, what is his / her exad share
on reverse side)
number / legal description
Mortgage / Contrad ir
March 1, current year
name on record is different than that of applicant, indicate below:
of mortgagee or contrect seller
Record number �
- O��Page number
as of I Is the applicant the sole legal or equitable
owneR ❑Ye's �'No
{ �JO, o� �
owned with someone other lhan spouse, indicale with whom.
Address of mortgagee or coniract seller (number and streef, city, state, ZIP
Name of assignee or other owner or holder of mortgage
(num6erand st�eef, city, �
DrawerNO..°?�7 •••••
s the property in queslion:
0 Real Property ❑ Mobile Horne QC 61.1-�
Does applipnt own property in any other If ye , , _ _ Has this deduction been requested on
county in indiana? C a d NO. ....:. � ••• property for current yeaR � Yes O No
�3�y ��7,�s�,00
COUNTY AUDITOR
Deduction approved in the amount of:
20 � y 20� 20
Signature
20
County Auditor
20
20
Date
20
We certify under the penalty of perjury that the above and foregoing information is true and correcl and that the applicants was / were
resident of Indiana and owner of ihe aforementioned property on March 1, 20
/ull
Person authorized b�
or by IC 6-1.1-12-.07
Address ofauthorized person
of