HomeMy WebLinkAboutMortgage_Burri�� 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�i = FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
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Presaibed by Departmenl of Loral Gwemrtrerrt Finance o��
To beRiledTlOP Sson oi by mail with lhe County Auditor o/ the county where the p�operty is located. �� File M� rk �
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Filing Dates: 7) Real Property: During the 12 months belore dune 11 of the year the deduction is to be effective.
2J Mo6ile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0( the year the deduc �on?s 1�o�6e effective.
See �everse srde fo� additional instnictions and quali�cations.
Applicant( erorcontracf
� �
Taxing Distrid
�
Asses ed valu oi real prop�
March 1, wrrent year
- see restriclions on reverse side)
�
GIBSON C
IKev numher lea I d scrioNOn Record number
a �,-. I -_� � -ao0 -�6�.1 �
_ /Y1� O.C�� �,/. � D �1 ` Page number
d<C.J �� o� �a
as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
�� Udb
Ii no, what is his / her exad
name on record is difterent than that of applicant,
of mortgagee or conVad seller
Address of mortgagee or contred seller (number and sf2et,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP
Does applipnt own property in any olher I If yes, what county?
county in Indiana?
20
1'1
Signature
approved in the amount of:
r� i,�
owned wifh someone other than spouse, indicale with whom.
/ /
state, ZIP
,. ocoo �- -ii os
s lhe property in question:
❑ Real Property ❑ Mobile Horrie (IC 61.1-�
- - �!` °" �'�` -
Dra�ver NO....G��•� •••••
What Taxing -
COUNTY AUDITOR
20 0�7 20 20
i
County Aud'Aor
Car�] NO
�c�a "
��uw�,
20
Date
C�'� I � �
..................
� i 35� CA�- �
20
We certity under the penalty of perjury 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
Person authorized by duly execuled Power of Attomey
or by IC 6-1.1-12-.07
xull resident address of applicant Address of authorized person
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