HomeMy WebLinkAboutMortgage_George�;�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�s• FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�w� JJ StateFOrtn43709 (R6/SO6) �
Resaibed by Deparimem of Laal Govemment Finance
INSTRUCTIONS: M(�R (l 5 28{fA�Mark
To be filed in person or 6y mail with the County Audito� o( the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months before ,lune 17 0( the year lhe deduction is to b�� ctive��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yLfar't�edu�n is to be eHective.
See reverse side lor additional instrucfions and qualifications. GIBSON COUNTY AUDITOR
(owner or c�(j'��t bky�r - see
Key number / legal
Record number , /5
(/
� � lS� \J�V.W r` l/lX - V`f- � S-��-Qi�(�. lyd�j um r O C� �as
Assessed value of real properiy as of MoRgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March t, current year March 1, current year owneR ❑ Yes ❑ No
If no, what is his / her exad share of
a ac� aq I
If owned with someone other than spouse, indicate with whom.
name on record is difFerent than IFiat of applicant, indicate below:
of moAgagee or contrad selier
Address of mortgagee or wntrad seller (number and street, city,
Name of assignee or
Address
owner or holder of moRgage
(numbe� and streef, city, stafe, ZIP code)
p �� �
�r �
I
� nc s�.
Dces applicant own property in any other If yes, what county? VYhat Taxing Dislrict? Has this dedudion been requesled on
county in Indiana? property for wrrent yeaR� Yes� No
- --`_-
COUNTY A /� /���
C�J
Deduction approved in the amount of:
20 �_ � 20
P I P
Signature
20 I 20
County Audilor
O � ��oC C�
�
I,u��.
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certify under the penalty of perjury that the above and foregoing information is true and corred and lhat the applicants was / were
leni of Indiana and owner of the aforementioned property on March 1, 20
(owners /ull name)
�n .
ent address of applipnt
� ��.�:� 9-. �-476
Person authorized by duly executed Power oi Attomey
or by IC 6-1.1-12-.07
of aulhorized person