HomeMy WebLinkAboutMortgage_Burkett (2)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S� J Sute Fwm a3709 (RS / 4-03) �� �1 �
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PresaiEed by Depenment of Local Gdvemment Finance � J
INSTRUCTIONS: AUG 2F�eM�K
To be �led in person or by mail with the CountyAuditor of the county whe�e the property is located.
Filing Dates: 1) Real Property: Dudng the 12 months before May 11 0/ the year tbe deduction is to be e(le`ctivE.,� ��,
2J Mobile Homes assessed under IC 6-L 1-7: Between January 15 and March 2 of the year t�ie deduction is�to be eNective.
See raverse side for additional instructions and qualifrcations. GIBSON COUNfiV AUBtfi6�
�
see resmcnongpi/reverse
Taxing Distrid T Key number / legal description
��f��;��� aG�� ��� �� ��
Sf real
March t, current year
as of Mortgage / Contract indebtedness unpaid as
March 1, current year
Record number �� �
U�
Page number ''
a�/��
f Is lhe applicant the sole legal or
ownef? ❑ Yes ❑ No
/�� ��-°a
no, what is his / her exac[ snare of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diHerent than thai of
mortgagee or contrad seller
indicate below:
of mortgagee or contrad seller (number and slreet, city, state; ZIP
Name of assignee or other owner or holder of mortgage
Addre s of assignee (number and street, city, stat , ZIP code)
- - .013 �
Does applicant own property in any other If yes, what county?
county in Indiana?
Deduction approved in the amount of:
20 �f
Signatu�
� � '
couNrv au�n
0
s the praperty in question:
❑ Real Property ❑ Mobile Home (IC 61.1
Dra���er NO..�•`��"'•....
I�( iested on
CaTC� \�• tt —• `G1. � Yes❑No
.�, i'yf�n�.�'p`Y_
ac�� tla�na.
20� 20 20
County Auditar
20
Date
�
We certiy under the penalty of perjury that the above and foregoing information is true and correcf and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power
or by IC 6-1.1-12-.07
of authorized person