HomeMy WebLinkAboutMortgage_Rathgeber STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ti.:s"t.
FOR DEDUCTION FROM ASSESSED VALUATION
" State Fond 43709(R71/6-09)
Prescribed
by Department of Local Government Finance
1
INSTRUCTIONS: yrtn
•To be filed in person or b mad with the County Auditor or County Recorder of the county where the m APR FiA 1ynt� d`
by ry ry property ryis located. t f f�LL^^JJ{e 1�
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. O aunty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months ry
before March 31 of each year the deduction is sought. n Recorder
See reverse side for additional instructions and qualifications. If01
1 OR
App&ant(owner or contract buyer-see restrictions on reverse life) GIBSON COUNTY AuUI
T District Key comber/legal 'prior Record number Page number
�o�.><a-� a 6 ,13-o/ -,too - o o.. 17 5 no J.y- 20 ( 0 5 1113
rack d real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
t,cement year Marta 1,current year date of appficaticn a equitable owner?
yal000 • 0 Yes 0 No
If no,what is his/her exact share of interest? if owned with someone other than cp-v,,.,indicate with whom
If name an record is different than that of applicant,Indicate below. Is the
Property in question:Annually Assessed
❑Real Property ❑AnnualyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller .
Address of mortgagee or contract weer(number and street coy,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 If yes,what county? What Tadrg Distrir
county In Indiana?
❑ Yes ❑ NO _ 71
5 1, `' 3
COUNTYAUDfTOR Card NO.
Deduction approved In the amount oh.
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20 20 20 20 20 I CU I •••
Signature County Auditgr r / 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/contract buyer of the aforementioned property on date application is filed.
Xr-, -(L es . i Date(month,day.year)
- Is . -C ASS
ull resident address of applicant(rum•.r and street,city state,and code)
- 606 )P ADS-0 ' /r.. % to 4- 1--• Li7G37
Person authorized by duly executed Power of Aitomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,dry,state,and ZIP code)
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