HomeMy WebLinkAboutMortgage_Ramseyi�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
«. J State Fam a3709 (R6 / SO6) o
� Presaibed �y Department of Loml Gmemment Finance /( Q
�/ �
�NSrRUCnoNS: FEB ��� ���
To be filed in person o� by mail with the County Auditor o( lhe county where the property is located.
Filing Dates: 1) Real Property: Du�ng the 12 months before June il of the year fhe deduction is to be e/fective.
2) Mobile Homes assessed under IC 6-1.7-7: Between January 15 and Ma�ch 2 of the year the���� be elfective.
See reverse side fo� additional instructions and quali/ications. GIBSON COUNTY AUDITOR
Applicant wner or cont�act buyer- ee 2sl
Tauing �stri c
��
- �� QGr�
Assessed value of real property as of
March 1, wrrent year
If no, what is his / her exad share of interest
tio �o verseside)
Key number / legal de ption
�
-oo����-oa/
Mortgage / Contrad indebtedness unpaid as
March 1, cunent year -
Ii
If name on record is difterent lhan that of applicant, indicate below:
�e of mortgagee or contract seller �
Address of n�oAgagee or conVad seller (numb and sfreet, ciry, state, ZIP
assignee or other awner or holder of mortgage
Record number
Page number
owner?
„ 36S"
c me soie iegai or
❑ Yes ❑ No
with someone other than spouse, indicate wilh whom.
- �❑ Real PropArty ❑ Mobile Horne (IC Cr1.1
Dra�ver \�0..!���� �• 3�S
Card NO.� ......:............ —
Address of assignee (number and s6eet, city, state, ZIP code) ` �
�-- ��'�'7 �� 0 ��5. �
Does applipnt own property in any other If yes, what wunty? What Taxi„ ��/�u r " Mas this dedudion been requested on
county in Indiana? property for curtent yeaf? 0 Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �
V
Signature
20
20 20 20
County Auditor
20
T�7
certify under the penalty of perjury that the above and foregoing information is lrue and coned and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
� �Full residei
1`
(�es�
pr,�ensv�lle Sn
Person aulhorized by duty execuled Power of Attomey
or by IC 6-7.1-12-.07
of authorized person