HomeMy WebLinkAboutMortgage_Haas STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
:. Township
FOR DEDUCTION FROM ASSESSED VALUATION
^t 'I-1' State Form 49709
Prescribed by Department of Local '1'ile'101'dt1C
Government Finance
INSTRUCTIONS: t=t, 1
To d girl be filed in person or by mail with the CountyAuditor or County Recorder of the county where the property is located. F U 2011
2
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought ❑ County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months c -
before March 31 of each year the deduction is sought er
See reverse side for additional instructions and qualifications.
Apgy.�m(owner or contract buyer-see . ' on reverse side) (�j c �y GIBSON COUNTY ^UDITfyR
Taxing 1 0 - - U Ky of I legal desolation�� D c� < YY Record number Page number
to a - as -Ri _ k.p5 -oba . S10a — a� ao// /F�9
Assessed value of real as of ' Mortgage/Contract indebtedness unpaid as of Mortgage/Contract bid unpaid as of Is the applicant the sole
March 1,anent year March 1,current year t date of application legal or equitable Amer?
06/ 400.06 es El No
If no,what Is his/her exact share of interest? If di
owned with someone other than spouse,indicate with whom r
If name on record is different than that of applicant,indicate below. Is property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home QC 6-1.1-7)
Name of mortgagee or contract seller -
fimert Ciemin- SEKV/c61 Of / 2w -Atmt,e/c4
'Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any other rrrrrr------((ffft�������'��'���� If yes,what county? What Taxing District? Has this deduction been requested co prEy
county in Indiana? ❑ Yes 1_y�No for anent year?
`` ❑ Yes No
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/con ct buyer of the aforementioned property on date application is filed.
Signature rs Ml name)/// � Date(month,day,year)
IL.Naria— "'T .1iaak, /2 /30 /20/2
resident of applicant(number and street,./J sta end Pcode)
57/S n/ 5So L-_-, P4 -or1A/ /n/ 9-766
-Person authorized by duly executed Power of Attorney or by IC 6-L1-12-0.7 ' Data(month,day,year) - '
Address of authorized person (number and street city,state,end ZIP code) •