HomeMy WebLinkAboutMortgage_Whitten (6)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
` State Pwm a3709 (R5/4-03) �
� PresaiDed Dy Department of Local Gtivemment Finance
INSTRUCTIONS: ���e� �
To be �led in person or by mail witA the CountyAuditor of the county where the property is located.
Filing Dates: 1) Real Pioperty: During the 12 months before May 11 0/ the year the deduction is to ffe
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be effective.
See reverse side /or additional inshuctions and qualifications. �'4 N 1 3 2��6
(owner
see
Assessed value of real property as of
March 1, current year
If no, what is his / her exad share of interest?
If name on record is different than
of mortgagee o'contract
Address of mortgagee or cont�ad seller
number / legal description
GIBSON
Record number O
O/� /1 �� D� .,rli� Page number ��
l —(.�' Q I.�LJ
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year ownef? ❑ Yes ❑ No
3 8s�c�
If owned wilh someone ather ihan spouse, indicate with whom.
indicate below:
and street, city,
Name of assignee or other owner or holder of mortgage
Is the property in question:
❑ Reai
Dra��•er NO..I'l� .:.�.��
Mobile Home (IC 61.1-
Card NO. .... �.c-�`
Address of assignee (numberand street, city, sfate, ZlPcode) /�L���
L
Does applipnt own property in any other If yes, what couniy? dion been requested on
county in Indiana? � „_�_ _, _. _�rrent yea(?0 Yes❑ No
Deduction approved in fhe amount of:
20
Signature
� �:
COUNTY AUDITOR
20 � 20 20
P
County Audilor
20
Date
20
We cxrti(y under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
(ull
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
�c��� d���c��u� ayy��can� ,vaaress or aumonzea person
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