HomeMy WebLinkAboutMortgage_Conner (6)`° R�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' : FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
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=�� Presaibed Gy DeDaNrenl ot Local Govemment Finance E,1 �
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INSTRUCTIONS: �R '� '= 200��1e Mark
To 6e filed in person or by mail with the County Auditor o/ the county where the property is locat `' `-�
Filing Dates: 1 J Real Property: During fhe 12 months before May 11 0/ the year fhe deduct' ' is to 6e e cbve. , �
2) Mo6ile Homes assessed under IC 6-1.1-7: Befween January 15 and Marc o/ th �e.deductio i�to be eHective.
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See reverse side for additional instructions and qualifications. GIBSON CO��TY AU;d'Oti �
Applicant (o r or ntract u e- see iestrictiqns o erse side) /
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Taxing Di ' Key number / legal descript Record number
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Assessed value of real property as of Mortgage ! Contrad indebtedness unpaid as of Is the applican the sole legal or equitable
March 1, wrrenl year March 1, current year owne(? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different lhan that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobite Home (IC 61.1-�
�me of moAgagee or contract seller �
Address of mortgagee or contrad selier (num r and st�eet, city, state, ZIP
Name of assignee or otner owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for curtent year? � Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signature (Lq County Auditor Date
I/ We certify under the penafly of peryury thal the above and foregoing information is true and corred and that the applirants was / were
��esident of Indiana and owner of the aforementioned property on March 1, 20
aignature (owner's /ull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Fuli resident address of applicant Address of authorized person