HomeMy WebLinkAboutMortgage_Phillips�� � STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
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�• Aesaibetl by DepaNnent of Loml Gwemment Finaixe
INSTRUCTIONS: APR 3 O 2�� Maric
To be filed in person or by mail with the County Auditor of the counfy where the propeRy is located.
Filing Dates: 1) Real Property: During the 12 months belois June 11 of the yea� the deduc6on is to be effectivev�'
2) Mo6ile Homes assessed under IC 6-1J-7: Between January 15 and March 2 of the.�RNte �aa�on is to be efiective.
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See reverse side fo� additional instnic6ons and qual�cations. GIBSON COUNTY AUDITOR
Applicant (owne or contract buye� - see restrictions on rev se side _
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Taxing District Key number / legal description Record num
' � �_I a 07 30 3 .�0 � • �� � Page number /� �
ssessed value of rea property as of Mortgage / ConUact indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? � No �
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If no, what is his / her exact share of interest? IT owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
Property ❑ MoWe Home (IC G1.1-�
� e of mortgagee or co�tract sell �` � ^
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Address of mortgagee or contract selier (num and st�eet, city, state, IP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st�eet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduc6on been requested on
wunty in Indiana? property for wrrent year? ❑ YesO No
COUNTY AUDITOR
DeducGon approved in the amount of:
20 C��� 20� 20 � q 20 20 20 20
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Signature Counry Auditor Date
I/ We certify under the penalry of perjury that the above and foregoing infortnation is We and cortect and that the applicants was / were
�sident of Indiana and owner of the aforementioned propeRy on March 1, 20
Si3nature (ownels full name) Person authorized by duly exewted Power oi Attomey
or by IC 6-1.1-12-.07
Full resident address of applicant Address of authorized person
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