HomeMy WebLinkAboutMortgage_Davenport a.,: .'.,
•
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year I
_, : FOR DEDUCTION FROM ASSESSED VALUATION
State Farm 43709(R 71/rug)
�� Prescribed by Department of Local Government Finance
I
File Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is 1
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought I ditty
2) Mobile/Manufactured Homes not assessed as Real Property Must Me during the twelve(12)n+dNths g ` Recorder
before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications. MAY ' 2013
Aparcant( �or contract buyer see restrictions on side) trN
a! l_] 4 ��� WcN a numoel
Taring Dint n(VJ nwnber/legs esaip I
-� �r-r dr, o 3 ce 1 . a 3 q-oa GIBSON C¢ rY At1D 6R'7D
Assessed value of real property as Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,atrtent year date of application legal or equitable owner?
/-(]3( 67D ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of app scant,indicate belay Is the property in quest n:Anruany Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
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,a Z1312/110 A .I�p1 of I • .
Does applicant own property in any other O r j 1J.�` District? Has this deduction been requested on property _
county in Indiana? ❑ Yes ❑ No j.[I r.. . rQ 1��p�1„_ ,, for anent year? ❑ Yes ❑ No
Deduction approved In the amount of: Mil itnard-
20 20 F' F ` u 20 20 20
I
Signature of County Auditor • County Date(month,day,year)
I 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 I contract buyer of the aforementioned property on date application is filed.
Sig (o et”lull name) Date(month,day,year)
Si ent dress of applicant(numbarard street tray,s S.and ZIP code)
Penton authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 - " Date(month_day,year)
Address of authorized person (number and street city,state,and ZIP code) .