HomeMy WebLinkAboutMortgage_Sides�e��' 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
's' = FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
_ -y State Fwm 43709 (R6l 5-061
�� Aesoibed by �epaNnenl of Loml Govemmenl Finance � I �
INSTRUCTIONS: .JAN 1 H Z00% File Mark
To be filed in person oi by mail with the County Auditor of the county whe�e the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months before ,lune 17 0l the year the dedu�asdn,�dective.
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 oi.t%e yea�fhe deduction is to be e(fective.
GIBSON COUNTY AUDITOR
See reverse side for additional instnictions and qual�cations.
Applicant (ownerorcontract uye�-see restrictions on reverse side)
Taxing i Key number / legai description Record number O�
%�� ) � -i8- /3 - !oi -ooi, i.3/ -o a �
�z � ��� O � � - O � I � � -Q� Page number -� -� �/
Assessed value of real property as of Mortgage / Contred indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March t, curtent year March 1, current year owneR ❑ Yes ❑ No
�osvo�
Ii no, whal is his / her exad share of interest? If owned wilh someone other than spouse, indicate with whom.
If name on record is difFerent than that of applicant, indicate below: Is the property in question:
I�f2eal PmpeAy ❑ Mobile Home QC G1.1-�
me of mortgagee or contrad seller �� � •
�Jz.aC_.
Address of mortgagee or contrad seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in any other If yes, what counN? �^"��' T�xing District? Has this dedudion been requested on
county in Indiana? property for cunent year? � Yes O No
Drawer NO.�•�•:-•�?•:l'
`� i R
Deductionapprovedinthear� CardNO• ••••••••••"""""'
zo �2 zo S$_ zo �_ zo 2o zo zo
�
Signalure County Auditor Date
/ We certify under the penalty of perjury that the above and foregoing information is true and corred and lhat the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) _ Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
F re i ent ddress of applicant Address of aulhorized person
Jo �oaR� D� ' o.� .Bi'an .<-r�, �