HomeMy WebLinkAboutMortgage_Byrns�.
rt�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
z FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
�'• �w� ! Sta:e Form a37091R51 a-03)
� Pre5ai0e0 Gy Depatlmeni of Local Government Finance ��
WSTRUCTIONS: MAY O 4Fi��lU'ark
To 6e liled in person or by mail with the County Auditor of the county where the propeRy is located.
Filing Oates: 1) Real Property: During the 12 months before May 11 o(the year the deduction is to 6e �' ,Q
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and MarcA 2 0l the year the�ducti is to be effective.
GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant (owner or confract 6uyer - see restrictions on reverse side)
��
Taxing DistriC
�:1 ' C
Assessed value of real property as of Mortgage / ContraG ir
March t, current year March 1, current year
no, what is his / her exact share of interest?
Record number
05
_ �' Page number a 1 �
J
> unpaid as of Is the applicant the sole legal or
owner? ❑ � ❑ No
If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
�me of mortgagee or contract seller
�
Address of mortgag or contract seller (number and slreef, city, state, ZIP
of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any olher I If yes, what county? What Taxir
county in Indiana?
Deduction approved in fhe amount of:
20 ��
Signature
20
COUNTY AUDITC
20 �g 20 O� 20
� �
County Audilor
Is the property
❑ Mobile Home (IC &1.1-�
--'^��iested on
�nN� Yes�No
..v�� �
�
�s-�3�
20
Date
3�]
,
We certify under the penalty of perjury that the above and foregoing intormation is true and corred and that the applicanis was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
�nat�re {owners /ull naq�e) Person authorized by duly executed Power of Attorney
' .lnn„�/,. f1i
or by IC 6-1.1-12-.07
Address of authorized person