HomeMy WebLinkAboutMortgage_StevensSTATEMENT OF MORTGAGE OR CONTRACT INDI
FOR DEDUCTION FROM ASSESSED VALUATION
t , Sfaie Fortn 43709 (R3 f 14q0) -
� PRSCibeC M State Board o1 Ta: COmmissiotiers
InsUuctions for filing:
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 12 months before May 11 of the year the dedudion is to be eftective. See
reverse side for additional insWcfions and qualifications.
FORM 5
SEP 1 9 2001
GIBSON COUNTY AUDITOR
Applicant (ownerorconhact buyer- see 2strictions on 2verse side) "
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Taxing Distrid number / legal desuiption Reco number
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, curtent year March 1, wrcent year ownef? ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
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If name on record is d'rfferent than that of applicant, indicate below:
e of mortgagee or contrad seller •
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Address of mortgagee contract selier (number and street, ciry, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, aty, state, ZIP code)
Does applicant own real property in any If yes, what counry? What Tauing Distrid? Has this dedudion been requested on
other county in Indiana? property for current yeaR� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signa re 09 County Auditor -;x Date
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�� We certify under ihe penalty of perjury that the above and foregoing infortnation is W e and corred and that the applicants was / were
ident of Indiana and owner of the aforemenGoned property on March 1, 20
Sig ure (owners /ull na Person authorized by duly executed Power of Attomey
or by IC fr1.1-12-.07
11 re ide d ess of a li t' : Address of author¢ed person
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