HomeMy WebLinkAboutMortgage_Vieke.¢ °"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ip
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FOR DEDUCTION FROM ASSESSED VALUATION
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�' �� Presmbed bY DePartment of Lacal Govemment Frence
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To be filed in person or 6y mad with tl�e CourrtyAuditor ot the county where fhe property is bcated.
Fd'o�g Dates: 1 J Real PropeAy: During the 12 months beJwe June 77 of fhe yea� the deducbon is to be elfective. ,�7�. ,Q,�
2J Mobile Hpmes assessed urrder IC 6-1.7-7: Behveen January 15 end March 2 0( fhe year the deductim is to be e1(ective. � �
SeeraversesideforaddSonalinsWCGOnsaMquaGfications. GIBSON COUNTY AUDITOR
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Ta>jn Di Q Key number / egal desaiption � RecoN numbet Paga mmiber
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Acsesud value af mal property as d Martfi 1. a+renl y�r Mortgage / ConVaq irde6tedness unpaid as of March 1. Is Ihe app6pnl ihe ade �e9al w equitahle owneR
wrrent 7ear �� D d v ❑ Yes ❑ No
If�+�al is his / her exed share of urterest? If owned with someone aher Ihan spouse, indiwte with whom.
If reme m recwd is d'rflererd �han Ihal of epplican4 i�rata below: ' Is Ihe prapeM1y in queslim:
❑ R�I Pfoperty ❑ Mobile Home pC G7.1-7)
� Nartre of mortgagce or canuacl
mortgagee a conUact seller (numbefand sGeeG
of as.dgnee a olher o.vner w hdder of moRgage
� Address W assignee (iwrtMei and sLeet. cilY• state.
Does ePplicaM own propertY in a�ry oUier
cauNy m Indiare7
❑ Yes ❑ No
� Ded�xtion approved in Ihe arnount of:
1 � � �1
It yes. what counry?
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Whaf Ta�dng Dis
COUNTYAUDROR
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SigreWre of Counb Audilor Camty Date (manN. tlaY. Yea�
I I We certify under ihe penalty of perjury ihat the above and fwegoing infortnation is true and corted and Ciat Ihe applinnLS was I were a resident of
Indi a d owner of Me aforemen6oned property on March 1, 20
Sig own s ( Dffie (monfh, daY• yea�
� idenl address af aodicaM (num6er pW street cdy et3 e%EiM Z,(P codp,) n
Powar of Altaney or by IC
or awrwr¢ed pgsm (nw,ne�and srreec Gr: srate.
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