HomeMy WebLinkAboutMortgage_Simpson�
� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION
'. �_ ! sute Fom: a3�o5 �as i a-o3�
� '«
P25cribed Ey Department of Locat Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1J Real Properiy: During the 72 months before May 11 of the year the deduction is to be e/%ctive! J � 1$ ZQQ6
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is fo be effective.
See 2verse side for additional instructions and qualifications. � �o� Q�
i
_ _ GIBSON COUNTY AUDITOR
(owner or contract1aGy�r - see
Taxing Disirict
� �
- ���;�:oU- �.
Assessed value of real propeAy as of
March 1, current year
no, what is his / her exaa share
Ii name on
m
side)
scription Record number
?aa -ooa.o�7-o.t
: .O o7_ D ^I pH9�er
o� ������
: �3, �
Mortgage / Contract indebtedness unpaid as ot Is the applicant the sole legal or equitable
March 1, current year owner? ❑ Yes ❑ No
��� bOZ�
If owned with someone other than spouse, indicate with whom.
than that of applicanl,
moRgagee or contrad seiler
Address of mortgagee'or wntrad seller (number and
Name of assignee or otheiowner or holder of mortgage
�„ �, e�-- 3 6 �
� �
� pra��'erNO•��•,/...
a� .... ..
Card ��� .... ..... •
— y:a_., . _ ,
Dec _...,�� approved in the amounf oL
20 �-�
P
Signature
2a � I zo �
?IP
below:
city, stafe, ZIP
county?
County
❑ Reai
❑ Mobile Home QC 61.1-�
What Taxing Distrid? Has this dedudion been requested on.,
property for current yea(? � Yes ❑ No
COUNTY AUDITOR
2� _ , 2�
20
Date
�
' We ceAify der e penalty of perjury that the ab nd foregoing in(ormation is true and corred and that the applicants was / were
resident Indian and owner of the aforement d property on March 1, 20
�nature ( wner 11 name) Person authorized by duly executed Power of Attomey
4 p� � or by IC 6-1.1-12-.07 �
applicant
�
o( authorized person