HomeMy WebLinkAboutMortgage_Gabbard�' STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
''� FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
! State Forrt; 63709 (R5/4-03)
�� PrescnDetl Oy Department of Local Govemmeni Finance f�� �� �� { �
�,� � f; t?� . fi Pi
� ����
INSTRUCTIONS: SEP FlIeJM��3
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months belore May 11 of the year the deduction is to be eNective.
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0/ fh �ear t, � he ded�f f✓ n� t�e�ffectrve.
See reverse side for additiona/ instructions and qualifications. CiBSON COUNTV AUD�TOR f
buyer- see restrictions on reverse
i axmg/ �uistnct
/ i��
Assessed value of real property as of
�vlarch 1, current year
If no, whal is his / her exact share of interest?
Key number / legal descnption Record number �
�jy, /� 7 7/, — �/ Page number /��
� C`iC�7S CJ V �
MoRgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current ye� owner? ❑ Yes ❑ No
If
If name on record is diHerent than that of applicant, indicate below:
'�me of mortgagee or contract seller
Address o( mortgagee or contract seller (number and stre t, city, state, ZIP
Name of assignee or
Address
owner or holder of mortgage
(number and street, city, state, ZIP code)
Does applicant own property in any olher I If yes, what county?
county in Indiana?
Deduction approved in the amount of:
20 �_ 20 ��r
/�� /
Signature .
with someone other than spouse, indicate with whom.
Is the property in question:
❑ Reat Property ❑ Mobile Home (IC 6-1.
`'�Y�-`�, U�.,,.� , 0 7- 3'1 7 I
« <- vB- � �s
Drawer NO. O3„-,,;P/.2/
Card NO . .....................
COUNTY AUDITOR
�4J/��
�
County Auditor
� � :
•
�een requested on
year?� Yes� No
zo � zo
�
Date
certify under the penalty of perjury tha� the above and foregoing information is true and correct and that the applicants was / were
fent of Indiana and owner of ihe aforemenlioned property on March t, 20
Signature (owners full name)
� � -'���CI�G-/V
Full resident address of applicant /
� S/� .s. /Ylfi/,f S7-
Person authorized by duly execuled Power of Attomey
or by IC 6-1.1-12-.07
of authorized person