HomeMy WebLinkAboutMortgage_Agnew��� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou� rownship Year
' FOR DEDUCTION FROM ASSESSED VALUATION
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� PrescnDed Dy Department of Loral Govemmeni Finance
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wsrRUCnorvs: S�� �P`l 2005
To be.filed in person or by mail with the CountyAuditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ the year the deduction is to be effective.
2) Mo6ile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0! the year the ded�i�[`.�'o,�4js tpSbi�affective.
See reverse side (or additional instructions and qualifications. GIBSON COUNTY DITOR
Applicant (ow e� or contract buyer- ee re 'ctions on rever side)
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Taxing Distrid Ke umber / le description Record number O{
�.��.� ^-�ci/ (/ �"�' d
Q/ 9,., �� 9_ �Q Page number �� �
Assessed value of real property as of MoRgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, wrrent year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
. . ❑ Real_Property ❑ Mobile Home QC 61.1-�
�me of mortgagee or coNract seller � d �
`y"`�"`- Drawer NO...a�.:.�7'a�%
Address o( mortgagee or contract seller (number and eet, city, state, ZIF �
� .
Name of assignee or other owner or holder of mortgage Card N� . .............. �
. ....�..
Address of assignee (numberand street, city, slate, ZIP code)
Does applipnt own property in any other I( yes, what county? What Taxing District? Has this dedudion �been requested on
counry in Indiana? property for wrrent year? �] Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �'� � 20 __Q_'� 20 � 20 20 20 20
P P �
Signalure County Auditor Date
� We certiry under the penalty of peryury that the above and toregoing information is true and corred and that the applicants was / were
e,resident oi Indiana and er o he aforeme ' operty on March 1, 20
Sign re (owner n e) Person authorized by duly executed Power of Attomey
/' � or by IC 6-1.1-12-.07
Full reside ad ss o pp' "nt Address of authorized person
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