HomeMy WebLinkAboutMortgage_Hynemane`°rt�` � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i�`'"' : FOR DEDUCTION FROM ASSESSED VALUATION
'�, �� Sute Fortn a3709 (Ra / 10-01)
��w
PreSCribeO by Depanrent ot Local Govemment Finance
INSTRUCTIONS:
7o be filed in person or by mail with the County Auditor ol the county whe�e the property is focated. �(��/ Q 1 20�2
Filing Dates: 1) Real Property: Dunng the 12 months 6e%re May 11 of the year tbe deduction is to be eHeL2iLe.
2) Mo6ile Homes assessed under IC 6-1.1 J: Behveen January 15 and March 31 0l t� e year the deduction is to 6e e/B�ective.
See reveise side lo� additional instiuctions and qualifications. ����-�–j/'/
GIBSON COUN7 �� AUDITOP. I
Applicanl ow e rcont cf yer- see restric " n everse side)
�-�/ /�-(J�. Q/L—
Taxing Distrid Key numb / legal descriplion Record number �
(�%Q O/� � O/ 7�r� Page number �r�Q�
/( O(
Assessed value of real property as of MoAgage / ContraU indebtedness unpaid as of Is the applicant the soie legal or equitable
March 1, currenl year March 1, rn�{/ent year � 5 p. owner? ❑ Yes ❑ No
a��SD�7o.7
If no, what is his / her exact share of interest? Ii owned with someone other lhan spouse, indicate with whom.
If name on record is different than ihat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobife Home (IC 61.1-�
�me of mortgagee or contrad seller
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does appticant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for wrrent year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
zo � zo Q_ zo zo 20 �� zo �'� zo -0 9
va- t� go,9- � P
Signature Counry Auditor Date
�We ceAify under the penalty of perjury that the above and foregoing information is true and wrred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
S' re (owner's full name) Person authurized by duty executed Power of Attomey
� or by IC 6-7.1-12-.07
ull resident dress of applicanl Address of authorized person
/ti �'iz � �v�