HomeMy WebLinkAboutMortgage_Miley (2) b£.��. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
<:=5 -r. FOR DEDUCTION FROM ASSESSED VALUATION
S Fbnd b Department art
Prescrirera bed by 709(R of Lad) Government Finance
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INSTRUCTIONS:
b J I loco be filed in person or by mail with the County or County Recorder of the county where the properly is located. L fit 2.611
ry
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought. u Auditor
2) Mobile/Manufactured Homes not assessed as Real Properly Must file during the twelve(12)months I''I
before March 31 of each year the deduction is sought 1-- Cow R;.. .er
See reverse side for additional instructions and qualifications. Ii,. 110ffal
V y//��/�. f /y GIBSON COUNTY AUDITOR
Taxi ig Distnet or _i 2 tuber on reverse i side)ti r /"rte 6eA l..
Taxing/[ Disldct f„Ir,•�.(Key/. num��,ber'/Iegalyrrd^esrnDwQheVJ.'{J' Record number Page number
7* d�, - !9 /�- 30d -coo. 36�- �� aa/3 3CoIh
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
March 1,arrest year March 1,amen
data of application gal or equitable amen?
ff no,what s his/her exact share of interest?/
000 ❑ Yes ❑ No
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 Home(IC 6-1.1-7)
Name of mortgagee or contrat ,per
Address of mortgagee orfnntracl seller(number and street city.state,and ZIP code) -
Name of assignee or other owner or holder of mortgage
3
Address of lie(number and street city,state,and ZIP cod /
. SS �
Drawer NO...
lY
Does applicant own property in any other If yes,what county? • what Taxing 3/vl/r j1
county in Indiana? `
❑ Yes ❑ No Card NO.
..................... to
COUNTY AUDITOR 71 6(o6 1 /?!
Deduction approved in the amount of ( "�
20 20 20 20 20 20 20
Signaj a°, '„`� County Data(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.
Slgnaouya�//J`(y eesfr�� Data(month,day.year)
Full resident address of applicant(number )�ci'ty�,rstate,and ZIP code)
'r y8/-f N gait Fr- 8,e tee1 f .iv- 2176 re
Person authorized by duly executed Power of Attorney or by IC 6-t.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street thy,state,and ZIP code)