HomeMy WebLinkAboutMortgage_Collins (9) F ate. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year -
FOR DEDUCTION FROM ASSESSED VALU�CIVQ�V� g�
r: State Fmm 43709 DEDUCTION
I 6-e9) �ii 11 dH.
Prrvibed by Department of Local Government Faance I
File Mark
INSTRUCTIONS: 1 ■,. NiE
b be filed in person or by mail with the County Auditor or County Recorder of the JUN w Form Ned .
• perry is located.
Ring Dates: f) Real Property:Must file during the year for which the deduction is sought V County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:M le du' th v 2)months
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for_.• nalinstructionsandqualifications. GIBSON COUNTY AUDITOR
Applicant(owner r. =biter, -/I. r. X� / tide)
Tailor District r 1, I Key number I I�ql desaip/O—/7—/O/_00O. J WO Racob/ m / J Page nt�5� .
Assessed value of real property as of MortgaV, ge/ indebtedness�unpaid as of Mortgage/Contract indebtedness unpaid as of Is the apprtrn the sole
March 1,one a year (Aaron 7,ni �/V date of application legal as equitable O• Yes
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: Is the property in question:Annually Assessed
��/////�/j�//'�/ ❑Real Property ❑Annually Assessed
��"` `^ �de
Mobde Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seder(number and steel,city state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street cry,state,and ZIP code)
Does applicant own arooertv in s... --- - at county? • What Taxing District? Has this deduction been requested on property .
for current year?
❑ Yes ❑ No
1 ��,�, .• COUNTY AUDITOR (-
Drawer NO........ Q� 1
.. 1I...... 20 20 20 20
LI_Card No. .........
$ X11151 61)
County Date(month,day,year)
_,./<—rL .c/V LA I 1
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.
SignaWre( h name) Date(rton h.day.year)
Jt1 . a-t(V fs2.2�;,
ut resident address of apprrant(number and street cay,state.and ZIP code)
1b lal 8' R. Adams Si- Po'AcQa 'ii '1'1 (pi 0
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 r Date(month,day,year)
Address of authorized person (number and street city,state.and ZIP code)