HomeMy WebLinkAboutMortgage_Martin f a. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township .1 Year
FOR DEDUCTION FROM ASSESSED VALUATION T
f t State Form
bed by 43709
Department nt of 6-09)
L 1� iI)
Prescribed try Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mat?with the County Auditor or County Recorder of the county where the property is located
� Q 1ry •
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. Court Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought Q ,,+.a.. .. -•er
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See reverse ' I.radditionalinstructionsa .q •lificat'••s. - , GIBBONCOIINT
APPtRant(ownr 7..r•-•buyer see ,. ,. ....:, YAUDITOR
Taxing District 4 lX (/r J `3 -400 - W Co). 04 /—O? y Record t J a q V m "-. /legal d_escription
Asses 1,�� papery as of MMaripace f Contract indebtedness unpaid as of dM gage I Conan indebtedness unpaid as of Is the epPllrant the sole year
ardn_ /� Pplication Iegal or equitable wmeR
7`400 ❑ Yes ❑ No
If no,what is his r her exact share 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
• ❑Real Property ❑Annually Assessed
Mobile •r - (ICS-1.1-7)
Name of mortgagee or contract seller f I I
a0 IS ��
Address of mortgagee or conhan Seller(number and sl D1 a11•C1 NO ( _
Name of assignee or other owner or holder of mortgage QM C2
Card NO.
Address of assignee(number and street,city,state,anc I r^l Q . ��
Does applicant own property in any other ,...o.....u��.r•. `� I Wnat Taring District? 1 Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for current year?
El Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount oh
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/contact buyer of the aforementioned property on date application is filed.
( re Date(month,day.Year)A.Full ent address of a cant(number and 4 coy:state,and ZIP code)
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 sheet.city,state,and ZIP code)