HomeMy WebLinkAboutMortgage_McCoy (3)��� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Count 7ownship Year
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� Presaibed by DeparUnent of Lo�l Gwemment Finance K
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iNSrRUCnoNS: MAR � 5 2008 File Mark
To be filed in person or by mai/ with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Propeity: Dunng the 12 months be(ore June 17 of the year fhe deduction is�j �
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 o(the� th ��q� is to be effective.
See reverse side for additional instnictions and quali(ications. GIBSON COUNT�
Applicant (owner or contract 6uyer- see restrictions,@� reverse side)
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Taxing Distrid Key num r/ legal description Record number
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Assessed value of real property as of Mortgage / ContraIX indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, wrrent year ownef� ❑ Yes ❑ No
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If no, what is his / her exad share of interesl? If owned with someone oiher lhan spouse, indicate with whom.
If name on record is different Ihan that of applicant, indicate below: Is the property in queslion:
eal Property ❑ Mobile Home QC 61.1-�
e of mortgagee or contra seller
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Address of mortgagee or contred seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and stieet, city, sfate
Does applipnt own property in any olher If yes, wl uested on
county in Indiana? ,.� �^� � S0 n �� .i� I Yes❑ No
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Deduction approved in the amounf of: ` (/ ��
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Signature � �
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We certify under the penalty of perjury that the above and foregoing informalion is true and corred and ihat the applicants was / were
sident of Indiana and owner of lhe aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power of Attomey
�C or by IC 6-1.1-12-.07
Full resident addre s f applipnt Address of authorized person
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