HomeMy WebLinkAboutMortgage_Simmons;�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�? FOR DEDUCTION FROM ASSESSED VALUATION
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Presaibed by Deparimenl of Lool Govemment Finance
INSTRUCTIONS:
Count Township Year
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To be filed in person or by mail with the County Audito� of the county where the property is located. �.
Filing Dates: 1 J Real Property: During the 12 months before ,lune 11 of the year the deduction is to be e((ectiv�, /�
2) Mobi/e Homes assessed unde� IC 6-iJ-7: Between January 15 and March 2 of the year lhe de�JEtRf�iS7i�fFective.
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See reverse side for additional instiuclions and qualifications. GIBSON COUNTY AUDITOR
Applicant (owner or cont buyer- see restrictions on reve e side)
Taxing Disirid Key number / legal description Record number o-7
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1 W�� a6- a-- a. a Page number �^^ l
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owne(? ❑ Yes ❑ No
/ 3 00('� ���5°0
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than ihat of applicant, indicate below: Is lhe property in question:
❑ Real Property p Mobile Home pC Fr1.1-�
me of mortgagee or contrad seller __
Address of mortgagee or contr��� �, state, ZIP
Name of assi; ' D���, 0��
➢la�`,�� �O•"'• ✓
Address of ass.
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Does applicant a C1Y �� yes, what county? What Tauing Distric[? Has this dedudion been requested on
county in �ndiana', property for curtent yeaR 0 Yes ❑ No
COUNTY AUDITOR
Deduction approved in lhe amount of:
20 �_ 20 �_ 20 O 9 20 20 20 20
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Signature County Auditor Date
�/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
a resident of Indiana and owner of the aforemenlioned property on March 1, 20
SigaatNre (owners /ull name) Person authorized by duly executed Power of Attorney
>C. ,^ ` 1��� �� or by IC 6-1.1-12-.07
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Full re�t address of applicant Address of authorized person
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