HomeMy WebLinkAboutMortgage_Mountsia�� � STATEMENT OF MORTGAGE OR CONTRACT INDE3iEI�NESS
' ; FOR DEDUCTION FROM ASSESSED VALUATION . Coun Township Year
b , w� . / State Farm 43709 (R6 / 5-06) � � � � �
� Presaibed by Oepartment of Lonl Gwemmenl Finance
1NSTRUCTIONS: MAY 2 5 ZO�7e Mark
To be filed in pe�son or by mail with the County Auditor ot the county where the property is located.
Filing Dates: 1J Real Property: Dunng the 12 months before dune � 1 0( the year the deduction is to�j�e� ec6NVE�
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the�year�tlle deducGon is to be eflective.
See reverse side foradditional instnictions and qual�calions. GIBSON COUNTY AUDiTOR
orconfracf buyer- see resMctions on reverse
� � �'Y�-���
Tauing Distrid
Assessed value of real property as of
March 1, wrtent year
is his / her exact share of interesl?
If name on record is
Key number / legal description' � Record number
�-�d�-O?— l�l Q�� O�� � Page number
March 1, curcent year
�o,o�v
indicate below:
unpaid as of Is the applipnt the sole legal or
owneR ❑ Yes ❑ No
�,�53
If awned with someone other than spouse, indicate with whom.
of mort gee or contrad seller ,
- -- , �+� ��- �'� • 2(�n-�-�-
s`s of mortgagee or wn seller (number and straet, city, state, ZIP
s the properfy
❑ Real Property ❑ Mobile Horne (IC Cr1.
Name of assignee or other ownei or holder of moAgage
Address of assignee (number —"` °�a+a..ZIP code)
Dces appliwnt own property ��Oa� �3��% � �� S ,-axing Distria? Has this dedudion been requested on
` J �__�"`,�-�'.i'
county in Indiana? �'! � � property for wrtent yeaf? O Yes O No
f � �.��f �S3a ITOR' .,
Dedudion approced in the amounl of: '
20 _�Z
Signature
�
20 �_ 20 20
County Auditor
�
Date
20
We certify under the penalty of perjury lhat lhe above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
��(owners ,full /name)
� �
:siaenc aaaress or appucam
/�
%'o o� CG �-rzl.' o wcr"•�SViGt� yZ�
�erson authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person