HomeMy WebLinkAboutMortgage_RussellSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VA�UATION
S � State Fam 63709 (R5 / 4-03) � �
� Prestribed by Oepanmem af Local Govemment Financa
INSTRUCTIONS:
Coun Township Year
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File,�v1�
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To be filed in person or by mail with the County Audito� of the county where the property is /ocated. �AN 2��5
Filing Dates: 1) Real PropeRy: During the 12 montAs belore May 11 of the year the deduction is to be eNective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the year the dedn�ction i��eNective.
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See reverse side for additional instructions and quali�cations. Cl
GIBSON COUNTY AUDITOR
A licant (owner or � nt cf yer- see resMctiq/�i on reverse i)
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Taxing Dislrid �Key number / legal description Record number 1�,��1
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O /�_� �pQ _ �. Page number � � �
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Assessed value of real property as of Mortgage / Contred indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, wrrent year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different ihan that of applicant, indicate below: Is the property in queslion:
❑ Real Pmperty ❑ Mobile Hortie QC 6-1.7-�
me of mortgagee or contraIX seller D� �
Address of mortgagee or contracl seller (number and sfreet, city, state, ZIP
Name of assignee or other owner or holder of mortgage D I J�� �
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Address of assignee (number and street, city, state, ZIP code
Does applicant own property in any other If yes, what wunty? 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:
20 20 20 �_ 20 20 20 20
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Signature County Auditor Date
�We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and ow of the aforementioned property on March 1, 20
ign ure (owners full n Person authorized by duiy executed Power of Attorney
or by IC 6-1.1-12-.07
F e' ddress applipnt Address of authorized person
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