HomeMy WebLinkAboutMortgage_Gibson (4)�.�� y STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
1\s'�; FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
`'., ..� • State Fwm 43709 (R6l 5-061 � � � �
Presmbetl by Depertmen� o( Lotal Govemmen� Finance
INSTRUCTIONS: ,f ,�e 2n�2007
To be filed in person or by mail with the County Auditor o/ the county where the propeRy is located. -
Fi/ing Dates: 1) Real Property: Dunng fhe 12 months before June I1 of the year the deduction is to be e!(ective.�j � �
2) Mobile Homes assessed under IC 6-1JJ: Between January 15 and March 2 of the year fhe deduct�i�is�7o �ffective.
See reverse side fo� additiona! instructions and quali�cations. GIBSON COUNTY AUBIfiOR
Appliwnt (owner or con cf buyer - see 2stri ions on reverse side)
Taxing Distrid Key number / legal desuiption Record number
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�,,,, O�� �h' n� f.,(� Page number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March i, current year March 1, current year owneR ❑ Yes ❑ No
P�b
If no, what is his / her exact share of interesl? It owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicale below: Is the property in question:
� Real Prop�ty ❑ Mobile Home (IC 61.1-�
me of moRgagee or contrect seller ��
Address of mortgagee or contracl seller (number and stieet, ciry, state, ZIP
O
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and streef, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for wrrenl yeaf?�] YesO No
COUNTY AUDITOR
Dedudion approved in the amount of:
20 � 20 �� 20 � 20 20 20 20
� r �
Signature County Auditor Date
We certify under lhe penalty of perjury that the above and foregoing information is lrue and corred and that the applicanls was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
i ure (owners (ull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07 �
Full esident add s of a lipnt Address of authorized person
2 a