HomeMy WebLinkAboutMortgage_Strunkel`° R'" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- : FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year .
�, � . � Slate Portn a37o9 (Ra / 70-01) .
yu �� PrescribeC by Departmenl ot Local Govemment Finante
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INSTRUCTIONS: �„IAK 26 �iIB,Mark
To be filed in person or by mail wifh the County Auditor of the counfy wheie the property is located. UUJ
Filing Dates: 1) Real Property: During the 12 montbs before May 11 of the year the deduction i•to be eNective. �/
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 the year the ded6ction is to be e/%ctive.
See 2verse side for additional instiuctions and uali�cations. , `����'�
Q GIBSON COUi� • � AUDITOR
(owner or
Taxing Distrid
- see restn tions on reverse side)
� �i •M� �i..�
number / legal description
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Record number O �
���' dv 5-ao a 9�- �a Page number �(�
Assessed value of real property as of Mortgage / ContraU indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, cune t year owne(? ❑ Yes ❑ No
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If no, what is his / her exact share of interesl?
If name on record is different than that
mortgagee or contrad seller
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contrad selier (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of moM1gage
Address of assignee (number and st�eet, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
What Taxing Distrid?
3 _ 3 — / � COUNTY AUDITOR � �
in the amount of:
20 £J,� 20
Signature
20 � I 20�
%���
County Auditor
20
s the property in question:
❑ Real Property ❑ Mobile Horne (IC 61.1-�
Has this dedudion been requested on
property for wrrent yeaRO Yes� No
20 ��
Date
�
/ We certiy under the penalty of perjury lhat the above and foregoing information is true and corred and thal the applicants was / were
resideni of Indiana and owner of the aforementioned property on March 1, 20
/ull name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
address of appli�nt // , n IAddress of authorized person