HomeMy WebLinkAboutMortgage_Douglas (4)Y�� y STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i' = FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
'>S ! State Fortn 43709 (R6 / SO6)
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.� Presaibed by Departmenl of Loml Govemmen� Fnance
INSTRUCTIONS: File Ma
To be �led in person or by mail wifh the County Auditor of the county where the propeRy is locafed. QPR 1 � 2���
Filing Dates: 1) Real Property: During the 12 monihs before June I7 0/ the year fhe deduction is to be effective.
2J Mobile Homes assessed under IC 6-1.7-7: Between January 75 and March 2 of the year ��yct�r�,to be eflective.
See �everse side fo�adddional instiuctions and qualifications. GIBSON COUNTY AUDITOR
Applicant (owner nt2ct buyer - see iesMcti �
�
Taxing District Key number / legal description Record number �
U� 6� s-aa- �oo -?oa.1?3^ �ber 353
Assessed value of real property as oi Mortgage I ConVact indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, cuRent year owner? � Yes � No
5 , D 00
If no, what is his / her exact share of interest? If owned wiih someone other than spouse, indicate wiih whom.
If name on recorcl is different than that oi applicant, indicate below: Is the property in question:
❑ Real Properry 0 Molzle Home (IC G1.1-�
N�e of mortgagee or contract seller � �
Address oi moRgagee or contract seller (number and sfreet, city, sfate, ZIP /1� �p g_ c f` jS
��- ��
Name of assignee or other owner or holder of mortgage
Address ot assignee (number and street, crty, slate, ZIP code)
Does applicant own property in any offier Ii yes, what counry? What Taxing District? Has ihis deduction been requested on
county in Indiana? property tor current year? QYes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
2o h 20�_ 20 o i 20 2o zo 20
� � r
Signature County Auditor Date
� I We certify under the penalty of perjury that the above and foregoing information is We and conect and that the applicants was / were
sident oi Indiana and owner of the aforementioned property on March 1, 20
:.., tur wner's full name) Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
Full resident address oi ap cant Address of authorized person