HomeMy WebLinkAboutMortgage_EverettSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
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�, PresaiEad Ey Departmen' of Lorai Govemment Finance �� + �y �:
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wsrRUCnoNS: NOV 0 7 20G5�e Ma�
To be filed in person or 6y mail wdh the County Auditor of the county where the property is located.
Filing Dafes: 1) Real Property: During the 12 months be%re May 11 0/ the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ th�yeaEthe de"tluction is to be e/lective.
See reverse side fo� additional instrucfions and qual�cations. v �
GIBSON COUNTY AUDITOR
(owner or contrjct �ujer- see res(ricti r� on
Key number / legal description
number
1 I/1/ /' � �f� 0� /�— Oa9� ?�O Pagenumber ��r/
Lt//I/LX�vI� (f ( O J
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, curtent year owner? ❑ Yes ❑ No
%/s�
If no, what is his / her exact share of interest? Ii owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
of mortgagee or contrad seller
Address of mortgagee or contract seller (number an�%�tieet, city� st
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Name of assignee or other owner or holder of mortgage ��
assignee (number and street, city,,�` � � ���� �
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Does applicant own property in any
county in Indiana?
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,���Po� � �� ���
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approved in the amouni of:
20 � I 20 ��
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Signature
,xing Distrid?
.1UNTY AUDITOR
20�� 20 20
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County Auditor
❑ Real PropeAy ❑ Mobile Home QC 61.1-�
Has this dedudion been requested on
property for wrrent year?0 Yes� No
20
Date
20
We certify under the penalty of peryury that the above and foregoing information is true and correct and that the applicants was ! were
�esident of Indiana and owner of the aforementioned property on March 1, 20
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resident address of applica
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S�. PiihcPfoO.S�
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person