HomeMy WebLinkAboutMortgage_Dilbeck (3)/� ��y STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i' = FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
. y State Fwm 43709 (R6 / 5061 Q
�• Presaibed by Departmenl of Local Govemmenl Finance ' o O
�} �
INSTRUCTIONS: MAR �i�e y�u��
To be filed in person or 6y mail with the County Auditor o/ the county whe�e lhe p�opeRy is located. 4
Filing Dates: i) Real P�operty: Dunng the 12 months before June 11 of the year the deduction is to be elfe tive.
2J Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0( the yea� th��cji�j'� be eHective.
See reverse srde for additional instnictions and qualifications. GIBSON C0� TY AUDI70R
buyer-:
z �-
Taxing
Cil(a' / /-U/- ,L
Assessed value of real property as of
March 1, wrrent year
what is his / her exad share of interest?
reverse s/de)� �
Key number./ leqal description
� j�,=7%
1 "5: o7/G - O�/
March 1, cumenl year
Record number
���
Page number
unpaid as of I Is the applicant the sole legal or equitable
owneR ❑ Yes ❑ No
�b, aU� I
If owned with someone other than spouse, indicate with whom.
If name an record is difterent than that of applicant, indicate below:
�e of mortgagee or contract seller
Address of mortgagee or conVad sP�ia< <�� �m�^- -id st city, state, ZIP
Q � /' Q.7.J-� lage
Dra���er NO..v.F.�..........
code)
Card NO. .......... � .........
n�„ � �'V Q QQC/. �� 3t wunty?
�,JCI I G�� �
Deduction approved in the amount of:
20 0� I 20
l
Signature
� ��y�
Fuli
s:
What Taxing District?
COUNTY AUDITOR
20 20 20
County Auditor
Is the property in queslion:
❑ Real Property ❑ Mobile Home QC 61.1-�
Has this deduclion been requested on
property for curtent yea(? � Yes � No
20
Dale
20
certify under lhe penalty of perjury that the above and foregoing information is true and corred and that the applicanls was / were
lenl of Indiana and owner of the aforementioned property on March 1, 20
(owner's full name) ,
address of applicant
�f5'- S S� G
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of aulhorized person