HomeMy WebLinkAboutMortgage_Hickroda`OR�"° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i+4 °. � FOR DEDUCTION FROM ASSESSED VALUATION
���y State Form a3�oe (Ra i iao7)
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PreSCnbcd by Departnent ol Local Govemmem Finance
INSTRUCTIONS:
Count Township Year
OCT i_ � �(hZa�k
To be filed in person or by mail with the County Auditor ol the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months be(ore May 11 0/ the year the deduction" �',,j//`�v be ef/ecti /f
2) Mobile Homes assessed under IC 6-1J-7: Behveen January 15 and March 3, �11�e yB,�c`�defir�G'oo.i.Nl��ef/ective.
See reverse side (oradditional inshuctions and quali�cations. �� GIBSON COUN'. v AUOIT�R
A plicant (ownerorcontract buyer- see restnctions on reve se side)
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Taxing Distrid Key number / legal description Record number D�_/ l �
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Page number
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Assessed value of real property as of Mortgage / Contrect indebtedness unpaid as of Is the applicant the so�e legal or equitable
March 1, wrrent year March 1, wrrent year owner? ❑ Yes ❑ No
Cl/ �OV
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 than that of applicanl, indicate below: Is the property in question:
� Real Property ❑ Mobile Home (IC 61.1-�
�me of mortgagee or contrecl seller j^
Address o( mortgagee or contrad selier ( mber and street, city, state, ZIP
Name of assignee or other owner or holder of moAgage
Address of assignee (numbe� and street, city, state, ZIP code)
Does appiicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for current year? � Yes ❑ No
/9 ' /� , � G COUNTY AUDITOR
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Deduction approved in the amount ot:
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Signature County Auditor Date
/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
S� nature (owners full name) Person authurized by duly executed Power of Attorney
� � or by IC 6-1.1-12-.07
Full resi ent addr'e/ss of icant Address of authorized person
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