HomeMy WebLinkAboutMortgage_Runyaniei �� � STATEMENT OF MORTGAGE OR CONTRACT INGEBTEDNESS
�+�� FOR DEDUCTION FROM ASSESSED VALUATION
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Prescribed by Oepartment of Loral Govemment Pinance
Coun Township Year
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located. �II � 1 � Z���
Filing Dates: 1) Real Property: Dunng the 12 months before June 11 of fhe year the deduction is to be e/fe'ciive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year tt�q,r/@ductiq{i jp to 6e effective.
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See �everse side for additional instructions and qualifications. U (/
GIBSON COUNTY AUDITOR
-see
side)
Taxing D'strid ' Key numb� / leg e cription Q Record
�.�n�� �� a � �5- 33 a � -003.
Assessed value of real property as bf MoAgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
Ma[ch 1, current year March 1, rrent year owneR "❑ Ye's � No ' '�
��9oa
If no, what is his / her exad share of interest? If owned wilh someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
mortgagee or contrad seller
Address of mortgagee or contract seller (number
Name of assignee or other owner or holder of mortgage
of assignee (number and street, city, state, ZIP code)
ZIP
❑ Real Property ❑ Mobile Horne pC 6�1.
Does applicant own property in ��°-"- ^ counry? What Taxing Distnct? Has this deduction been requested on
county in India�^'�� ��Q g6� property for current year? Q Yes � No
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Dedu
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COUNTY AUDITOR
20 I 20
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Signature Counfy Auditor
20
Date
20
We ceAify under the penalty of perjury lhal lhe above and foregoing informalion is true and corred and that the applicants was / were
`esident of Indiana and owner of the aforementioned property on March 1, 20
(owners full name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person