HomeMy WebLinkAboutMortgage_James (2),i *'. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
��i�� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�' Siate Fortn <3709 (R6 / 5-06) . .
� �M� . . .. . . . . .
Presvibed by Depariment of Lopl Gwemment Finance
To be�i/ edTIOP Sson or by mail wilh the CountyAuditor of the county where the property is located� ��Fil�Adpric� �
Filing Dates: i) Real Property: Du6ng the 12 months before June I1 0/ the year fhe deduction is to be eflective. �
2) Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 of the yea� t��dgcGo2 LatQ be effective.
See reverse side for additional instructions and qualifications. �
O �16� ��
Applicant
on
Key number / legg' I descriplion
�G�r�� a ��a-�
Assessed value of real property as of Mortgage / Contrad ii
March t, curcent year - March t, currenl year
� 9�0,
If no, what is his / her exact share of inleresl?
If name on record is different lhan that of applicant, indicate below:
moAgagee or contrad seller
Address of mortgagee or contract seller (number and street,
Name of assigriee or olher owner or holder of mortgage
assignee (num6erand stieet, city, state,
Does applipnt own property in any other If yes, what county?
county in Indiana?
)eduction ap� S � � ""
� Eh N �
zo oy
Signature _
(.J J �M� S
Dn'��'�
0
GIBSON COUNTY AUDITOR
Record number � i
/
��_r�� P umber � a�
�j
unpaid as of Is the applipnt the sole legal or
- owneR ❑ Yes ❑ No
r"
If owned wilh someone other than spouse, indicate with whom.
ZIP
VJhal Taxing Distrid?
NTY AUDITOR
.,�unry Audilor
Zo
Is the pr
❑ Real
❑ Mobile Horrre pC 61.1
Has lhis deduclion been requested on
property for curtent yearl0 Yes ❑ No
�
Date
20
We certify under lhe penalty of perjury lhat the above and foregoing infortnation is true and corred and that lhe applicants was / were
resident of Indiana and owner of lhe aforementioned property on March 1, 20
Full
Person authorized by
or by IC 6-1.1-12-.07
l�'j (o-�,U TAddress of authorized person