HomeMy WebLinkAboutMortgage_Blume (3) f'�. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
tde: FOR DEDUCTION FROM ASSESSED VALUATION
: State lambyDe (R11,6 IL•
Prescribe d by Department of Local Government Finance
INSTRUCTIONS: FID
'Forth filed with
To be Ned in person or by mail with the County Auditor or County Recorder of the county when the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought JUL _ 9 ❑®�3 County 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 County Recorder
See reverse side for additional instructions and qualifications. 7.lPIP
Applicant(owner or contract b -aeettirtions on rev/erse A see) % GIBSON COUNTY AUDITOR
Ta District I ey number legal description b number Page h
um
Dom--
col & -iq_ 3a - /0/_ co /. 4, /-oX • l.3 ;. 9 0
valued real property as of Mortgage/Contraa indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,anent year March 1,anent year data of application legal or equitable awneR
(0e 500 ❑ Yes 0 N
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 difter/ant than that at applicant,Indicate below Is the property in question:Annually Assessed
p Real Property ❑ArnualyAssessed
Mobile Home(IC 6-1.1-T)
Name of mortgagee or contract seller /) . //{7\`
Address of mortgagee or contract seller(number and meet city,s te,and ZIP code) C//� V /r `�,r/
Name of assignee or other or or folder of mortgage �� �" `\� \
4
Address of (number and street city,sbte,and LP code)„ - ,y 1
Does applicant own p petty in any other If yes,what coou nty? - VX What Taxing District? /� G�'
county in Indiana? ❑ Yes ❑ No Ito.
COUNTY AUDITOR
Deduction approved In the amount at
20 20 20 20 20 20 20
Signature o County Auditor - 1 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 I contract buyer of the aforementioned property on date application is filed.
Signs (Dane lull harm _ j Date(month,day,year)
/ Full resident address of applicant G/CC[ /(nunuml(number and street sty,state,arM )
& to 370 S. 110 E , 1� , 11. 47639
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 meet dt state.and ZIP code) .