HomeMy WebLinkAboutMortgage_SaylorR.�
STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
F FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�• � � / Siate Fwm d3709 (RS / a-03)
� P2scribed by Department of Local Gdvemment Finance
INSTRUCTIONS: � �� ��
To be filed in person or by mail with !he County Auditor of the county where the property is locat
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ the year the deduction is be
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be eflective.
See reverse side /or additional instiuctions and qualifications. MAY s 2��5
Applicant (owner or contract bu - see restrictions on re rse side)
GIBSON COUNTY AUDITOR
Taxing Distrid y nu ber / legal d ription Rewrd number O�
� � (I\ ^ Q � ^ O age number �Q �.\
\1 V
Assessed value of real prop y as of. . Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, wrrent year owner? ❑ Yes ❑ No
lV � �
if no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate with whom.
It name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
me of mortgagee or contract seller
Address of mortgagee or contract seller (number and st�eet, cit , stafe, ZIP
Name of assignee or other owner or hoider of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does appliwnt own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for wrrent year? � Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
20 O� 20 20 O y 20 20 20 20
� � P
SignaWre � County Auditor Date � _
�
� We certify under the penalty of perjury that lhe above and foregoing information is We and correct and that the applicants was /were
a resident of Indiana and owner o( the aforementioned property on March 1, 20
ignature (owners (ul! name) Person authorized by duly executed Power of Attorney
� or by IC 6-1.1-12-.07
F I �esident addre f appti nt Address of authorized person
� � \ b� Q h `�-*�