HomeMy WebLinkAboutMortgage_Przymus (3) -n��1�_.� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year I
FOR DEDUCTION FROM ASSESSED VALUATION g
t _ f, State Farm 43709(R11/6-09) F ® L E
Prescribed q'Department of Load Government Finance JR1 J
File Mark
1 INSTRUCTIONS: ;fled•7'
To be Ned in person or by mail with the County Auditor or County Recorder of the county where the property is located. M Ay.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. 9 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must h7e during the hveke(12)months
before March 31 of each year the deduction is sought - ILA Ji runty Recorder
See reverse side for additional instructions and qua lifications. GIBSON COUNT' AD D •
Applicant(r r or contract buyer-see restrictions
�Recant number number
VeN - �a -.lox - r� - a� . .a (4949- ca g /3
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Math 1,anent year March I,cement year date of application legal o) itable owner?
i..apt)-o zit es 0 N
If no,what is his/her exact sham of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below „ice property in question:Annually Assessed
Real Property El Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of rtto ee osetler SD
Address s of Pjt
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 ovm property in any other If yes,what county? - What Taxing District? Has this deduction been an property
county in Indiana? for current year? ❑ No -
❑ Yes No es
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/contract buyer of the aforementioned property on date application is filed.
(owner's 7W alicrzz. Date(month,day,year)
�g�resident of appfrant(nJmberan0 jstate,and ZIP code)
Y e ocolC 4'*tt,n t. 1—P. S-3 (—!-1 co-10
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sleet,(ry,state,and ZIP code)