HomeMy WebLinkAboutMortgage_Tate (2)dyf-�"a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
�._ _� FOR DEDUCTION FROM ASSESSED VALUATION Gibson Owensville 2ot3
• ��' Sta:e Fortn 43709 (R77 / 6-09)
- Prescri0etl by Oeparimem of Local Go�emmenl Finance
File Mark
INSTRUCTIONS:
To be /iled in person a by maiL F i 1 tl wit
Filing Dates: 7J Real Property: Must be compleled and dated in the calendar year for which the deducfion is soughf. �
Musf be filBd with [he County Auditor or County Recorder o7 fhe county where the propeRy is locafed
m orbe7ore January 5 o/the immediately succeeding calendar year. County RecorAer
2) Mobile /Manu/actured Homes not assessed as Rea/ Property: Musf file wilh (he CountyAutlitor o/the
counry where Ne p�operry is bca(ed dunng rhe NieNe (72) months befoie Malch 37 of each year fhe
deduction is sought C � _
See reverse siCe foraatlicional ins[nxtions and qual�cacions.
Appicant (amer w cwitract dryer - sre restrictions on reverse siee)
Clayton R. Tate GIBSON COUNTY AUDITOR
Tazing �istrict Key riumCer / legal descripibn RecoW � Pa�e_n ber
Owensville 2E17-12-203-000.563-022 7
Assessed rWue of reai pioperty as d tAoripage/ Contract mdeotearress unpaiE as M Mwtga9a ! Canuact intlebtedness unpaid as ol Is Ne appl&an1 lhe mle
March 1, currPnl year Marrh 1, curtem year tlace of apphcation legal or equilada owneY!
70,000 68,240 �❑ Yes ❑ No
nerexact
11 rame on reard is di4erenl lhan Uiat of appticant, indicate Eelow:
Nartre of mortgagea or contract seller
Wells Fargo Bank, N.A.
Pdd(ess of mortgagee or mntreC seJier (numbu an0 sbeeL my. state. ard Z!P �-•�.
2650 Wells Fargo Way 3rd Floor Minne; -"-. ---'"�^ (y��
Name of assi9rtee or o:her owner w �oMer W mortga, � J�Q ,�[�b � �Of� [jaf�
.t� �yV� I
It owrn.�d NT�h someone oiher than spouse. iMicate wiN wfiom
anC SreeL crty. 4ate, ac
Dces applinirt wvn property in any other ,
counry in InCiana?
❑ Yes ❑� No
llra�vcr NO ...............
1\O. . �. I.�.�.........
Ca�_� ...
Is the property in Ques�ion: Annualy Assessed
❑J Real Property ❑ Mnua�yPSSessed
Has �li¢ dedupion been requeste0 on property
(ncwrPntr��? n Yes ❑ No
COUNTY AUDITOR
Deduction approred in ihe artwunl oE
20 _ 20 _ 20 _ 20 20 _ 20 _ 20 _
Signature of CounryAudiWr Co�nry Date (month. day. yea� '
I! We certiry under Ne penalty oF perjury that tne above and twegoing infortnauon is We and conect and ihat the applicant is a resident of Iraiana and
owner I conVact buver ot Ihe aforementioned propem on date appiicalion is filed. �
Sig`am vme/s fl neme) . Date (mwn, dey, year)
l /
FW 25iden! af app6cant (romberand streel, dty, sfae, anC ZlPtode) .
305 W arrick St, Owensvitle, IN 47665
Person auUror¢ed Gy duly arewte0 Power of Attwnay or by IC G l.1-12-0.7 Dala (monM, day, yea�
Pddress of au�a¢ea person (number andstreet, cily, stafe, an0 ZlPCode)