HomeMy WebLinkAboutMortgage_Brewer (3)`°rt"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' � FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
> State Porm a37o9 (Ra / tb-0t)
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Prescribea by Department ot Loral Govemment Finance �
INSTRUCTIONS: � File Mark
To be filed in person or 6y mail with the County Auditor o/ fhe county where the property is loca� � Z�02
Filing Dates: 1) Real P�opeRy: Dunng the 12 months be%2 May 11 0/ the year the deduction is'r be e ective.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and Marc 1 0/ the ygar fhe' dedu 'on to 6e eHective.
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See reverse side for addifional instiuctions and qualifications. ry�
GIBSON COUNTY AUDITOR
Applicant (owner o confract buyer- see restric ' ns on reverse side)
Ta�cing Distrid Key number / legal description Record numbe� �—��� 2
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Page number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is lhe applipnt the sole legal or equitable
March 1, current year March t, current year owne(? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone olher than spouse, indicate with whom.
If name on record is diHerent than that of applicant, indicate below: is lhe property in question:
❑ Real Property ❑ Mobile Hmie (IC 61.1-�
�me of mortgagee or contract seller � T%) � r q
Address of mortgagee or contracl seller (number and street, city, state, ZIP
Name of assignee or other owner or holder oi mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for curtent yeaf? � Yes � No
COUNTY AUDITOR
Deduction approved in the amounf of:
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Signature County Auditor Date
- We certify under lhe penalty of peryury that the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
Si nature (owners full name) Person authorized by duly executed Power of Atlomey
��_ or by IC 6-1.1-12-.07
Full resident address of applicant �o�+ � f�� ,.�u Address of aulhorized person
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