HomeMy WebLinkAboutMortgage_Brewster (2)� � � STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
! State Farm 43709 (R6/ 5-061
� Prescribed by Depanmenl of Lonl Gwemment Financa
INSTRUCTIONS: Fil Mark
To be �led in person or by mail with the County Auditor of the county where the propeRy is located. T 7p��g
Filing Dates: 1) Real Property: Dunng the 12 months before June il o/ the year the deduction is to eKe!°�iv� / �
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2.of the year the deduchon to'be-Effective.
See reverse side for additional instiucGons and qual�cations. A PR 2 3 Z���
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Applicant(owne�o�con uyer-seeiesVictions,o�) � �`G�S
`�/�\�` �� � �� I �1� _� GIBSON COUNTY qUD
Taxing District Key number / legal description Record number '-")
n - r li 1
Assessed value of real property as of
March 1, wnent year
no, what is his! her exact share of interest?
a� ►�� �- � a�8 Page number � lt� a
T �-
MoRgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equ
March t, current year . owner? ❑ Yes � No
�'�O�c
If ovmed with someone other than spouse, indicate with whom.
Ii name on record is diRerent than that of applican[, indicate below:
Name of moRgagee or contract seller
� \`� 'v����
Address of mortgagee or conVact seller (number and sfreet, � y, state, ZIP
or other owner or holder of mortgage
street, city, state, ZIP code)
applicant own property in any other If yes, what county? What Taxing District?
y in Indiana?
� • COUNTY AUDITOR
)eduction approved in,tM� �
/
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zo_ � ��a"eYl`t�"'�,�oa ._
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20 _ _ _ _ I zo
Signature CAr _ _.,unty Auditor
❑ Real Property ❑ Mobile Home pC 61.1
property for wrrent year? �J YesU No
20
+�
I/ We certi ,.enalty of perjury that the above and foregoing infortnation is We and correct and that the applicants was / were
�sident c.. �mana and owner oi the aforementioned property on March 1, 20
��no�
�0Z �. �oc�.cCT 'Y7�O76 r0� F.)r�ia.�-N
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person