HomeMy WebLinkAboutMortgage_MitchemSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn a37os (Ra / 70-07)
Prescribed by DeDartment of Loral Govemment Finance
To be �led in person or by mail with the County Auditor ol fhe county whe�e the property is located. �
Filing Dates: 1) Real PropeRy: During the 12 months belore May 11 0/ the year the deduction is to be effec��L � i Z�02
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0/ the ar the deduction is to be effective.
See reverse side for additional insbuctions and qualifications. /��`��%� j'"
GIBSON COUicTY qUDITOR I
Applicant wner or contract buyer - s`ee 2stric � ns on rev rse side) .,
t T
Tauing Dis rid Key numb / legal des 'ption Record number Q�
O/�O 10 n o�O Page number ��
.1 da �
Assessed value of real property as of Mortgage / Contred indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March _1, current year owneR ❑ Yes ❑ No
5%` 00 •av
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate witn whom.
If name on record is different than that of applicant, indicate below: Is lhe property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
ne of mortgagee or contraIX seller
Address of mortgagee or contrad selier (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sfreet, city, state, ZIP code)
Does applipnt own property in any other If yes, what wunty? What Taxing DistrJt? Has this deduction been requested on
county in Indiana? property for wnent year? � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �� 20 �� 20 _� 20 � 20 _Q� 20 20
oA— � � � � %
Signature County Auditor Date
We certify under lhe penalty of perjury that the above and foregoing information is lrue and corred and thal the applicants was / were
•esideni of Indiana and owner of the aforementioned property on Marcn 1, 20
ignature (o ers lull na e) Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Full resid t addres f appli t / Address of authorized person
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