HomeMy WebLinkAboutMortgage_Ricketson� ;.
�� "� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
's: �9 �,'= FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�. �_ y State Fortn 43709 (R6 / SO6)
Presaibed by Depariment of Local Govemment Finance
�«
INSTRUCTIONS: �UN 1 �i1��ark
To be filed in person or by mail with the County Auditor of the county where the property is located. � �
Filing Dates: 1) Rea/ Property: During the 12 months befors ,lune Il o/ the year the deduction is to be e �ve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year��erJ� to be effective.
See reverse side for additional instnictions and qualifrcations. GIBSON COUNTY qUDITOR
Applicant (owne�orcont ct buyer- see restrictions on reverse side)
,� U��
T ing Disirid ey number / legal description Record number �0O 7
�- i2la —/� /3 -�OY-OCY],OSY-0 Jb Page number 3 a. O%
Assessed value of real property as of Mortgage / Contred indebledness unpaid as of Is lhe applicant the sole legal or equitable
March 1, wrrent year March 1, current year owneR ❑ Yes ❑ No
`°S /oY, G �.� �- �
If no, what is his / her exad share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different ihan that of applicant, indicate betow: Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
�ne of mortgagee or contrad seller
0
Address of mortgagee or wntrad seller (number nd street, city, state, ZIP
Name of assignee or other owner or holder of mortgage ��� —��O � I
Address of assignee (numberand street, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? � I O� � C4 7 5' a� requested on
county in Indiana? ❑ Yes❑ No
� v� � �
COUNTY -,G�X'��
�
Dedudion approved in the amount of:
20� 20� 20 20 �� �• � V D
1 �
Signature County Auditor Date
' We certify under lhe penalty of perjury ihat the above and foregoing information is true and corred and lhat the applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
Sign ture ners full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
F II resident address of a ip Address of authorized person
a3 �. _ . F