HomeMy WebLinkAboutMortgage_Beckelry� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
z FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
,. ! Siate Fwm d3709 (RS I a-03)
� IN�
PrescnOeE Cy Departmem ol local Govemment Finance
INSTRUCTIONS: � �� �e �
To 6e filed in person or by mail with the CountyAuditor of the county where the property is loc e
Filing Dates: i) Real Property: Dunng the 72 months before May 11 olthe year the deduction is to be e ec �ve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the ygaAthe,dedu�,/tjq�is to be ef(ective.
See reverse srde lor additional instroctions and qualifications. M Y L�l LUU�
Appiicanf (owne�orcontrac yer-s�e
Taxin Distrid
As essed value ot real property as of
March 1, current year
I( no, what is his / her exacl share of
on reverse
�
�/S'--�SO��C
Mortgage / Contract indebtedness unpaid as
March 1, current year
GIBSON
Record number D
Page number n�-,� /
✓b�
f Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
I( owned with someone other ihan spouse, indicate with whom.
If name on record is different Ihan thai of applicanf, indicate below:
me of mortgagee or contracl seller
Address o( mortgagee or contred seller (number an sf�eet, cify, state, ZIP
Name of assignee or otner owner or holder of mortgage
Address of assignee (num6er and st2et, city. �'-te, ZIP code)
Does applicaM own.o�^-'.- �,.•�''�� at counry? What Taxing District?
county in.lna'� ' ^
�Ca e��y0••'':' a ��,�.
.� /, 3.
U 7� , .
Dea CaCa�O . COUNTY AUDITOR
2�� P_ ( 20�.
�
Signature
20 0� 20 20
P
County Auditor
s ihe property in question:
❑ Real Property ❑ Mobile Home (IC 61.
Has ihis deduction been requested on
properfy for curreni year?� Yes� No
�
Date
20
� We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicanis was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
'natur - ner I 1 name) Person authorized by duly executed Power of Attomey
° iZ �
or by IC 6-1.1-12-.07
resident addi�ss o( applicant Address of authorized person
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