HomeMy WebLinkAboutMortgage_Lamb� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S / State Fortn d3709 (RS / 4-03) '
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� PrescnDeC by Departmeni of Local Govemment Finance
INSTRUCTIONS: � g� �ark
To be filed in person or by mail with the County Auditor ol the county where the property is locate �
Filing Dates: 1J Real Property: During the 12 mon[hs belore May 11 of the year the deduction is e eW�c
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the yea� the deduct�on �s effective.
See reverse side �or additional instn�ctions and qualifications. FEB Q� Z��S
Applicant (ownerorcontra uyer-cee res�tion reverse si�)
GIBSON COUN7Y qUDITOR
Taxing Dislrid Key mber / iegal description Rewrd number � C
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, � �an s�, Page number ` C �p
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year ownef? ❑ Yes ❑ No
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If no, what is his / her exaci share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different lhan that of applicant, indicate below: Is the property in question:
❑ Real Pmperty ❑ Mobile Home QC E1.1-�
' me of moAgagee or contract seller n��
C
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder oi mortgage
Address of assignee (number and sheet, city, state, ZIP code)
Does applicant own property in any other If yes, what wunry? What Taxing District? Has this deduction been requested on
county in Indiana? property for wrtent year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 20 0 20 �� 20 0 20 20 20
P � P
Signature County Auditor Date
'� We certify under the penalty of pe�jury that the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power oTAttorney
� or by �C 6-1.1-72-.07
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� esi n address of applicant � Address of authorized person
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