HomeMy WebLinkAboutMortgage_HeimbuecherSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION . Coun Townshi Year
♦ stare Fwm a3�os (rts i a-oa) �,/
� PtesaibeA by DepertmeM ol Local Govemment Finance ��
iNSraucnoNS: JAN 0 4 le Mark
To 6e filed in person or by mail with the CountyAuditor of the county where the property is located. 200�
Filing Dates: 1) Real PropeRy: During the 12 months before May 11 of the yea� the deduction is e eflective.
2) Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 of t�e�th��ction is to be eHective.
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See reverse side for addiUonal instructions and qua/�cations. GIBSON COUNTY AUDITOR
Applicant (owne contiact buye - see resMctlon on reverse side)
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Taxing District Key number / legal description Record number �
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���J D/� _ ��,! � � , (f Page number �� —
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Assessed value of real property as of MoRgage ! Contrad indebtedness unpaid as of Is the appli , t the sole legal or equitable
March 1, curtent year March 1, currenl year owneft ❑ Yes ❑ No
If no, what is his / her exad share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than ihat of applicant, indicate below: Is the property in question:
❑ Real Pmperty O Mobile Home pC 61.1-�
me of moAgagee or conVad seller ,
Address of mortgagee or contrad seller (number and straet, city, state, ZIP •
, D (,- / 30
Name of assignee or other owner or holder of mortgage
Address of assignee (number and stmr.t_ ri�v_state. ZIP code)
Does applicant own property in art DCa,�.er \rO �M�— ���D istrid? Has this dedudion been requested on
couny in Indiana? `"'��>•� property for wrrent year? � YesO No
Card i\'O. ..
DeducGon approved in the amounf of:
20 � 20�$ 20 20 20 20 20
P � �
Signature County Auditor Date
�l We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforemenlioned property on March t, 20
Si ture (owne;s 11 nameX�L�.t".s-`- Person authorized by duty executed Power of Attomey
� or by IC 6-1.1-12-.07
Full resident address of applipnt Address of authorized person
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