HomeMy WebLinkAboutMortgage_Greenwell STATEMENT OF MORTGAGE OR CONTRACT INDEBTED S�� CoE 11,�Township I Year
„,, FOR DEDUCTION FROM ASSESSED VALUATION
, t Stale Farm 03709(R11/6-09)
Prescribed by Department of Loral Government Finance
INSTRUCTIONS: JUL 12 2013 File Mark
Form filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: f) Real Properly:Must file during the year for which the deduction is sought. n • County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the hvehfl ll
before March 31 of each year the deduction is sought Recorder
GIBSON COUNTY ALDI
See reverse side for additional instructions and qualifications. -Applicant(owner or contact buyer-see on side
*isjak.ict number/19,g tl tan Record number Page number
�/,�,�` a‘4� iQa ca�1'S/// /Id 1 3 104
Assessed value of real rags of /Conuad indebtedness unpaid as of MortgagefCContact indebtedness unpaid as of is the applicant the sole
March 1,current year Marts I.arnent date of appr�cabon legal or equitable owner?
xs cod ❑ Yes 0 No
tl no what is his/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
?eat Property ❑AnnuallyAssesSed
Motile Home(IC 6-1.1-7)
Name of mortgagee or ccE:VIler J2.—+//
Address of mortgagee or contract seller(numb r and testeel,ray,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and St., \ _— /,_/` - —
Does applicant own property in an' J //�/n`�� ��• .ir2? Has this deduction been requested on property
mainly in Indiana? ❑ YI VP� � for Wrtenl year? ❑ Yes
'—`a-Niq Lc. ❑ No
Deduction approved in the amo_ 13 S /U`'/
20 20 20 I20 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 aforem-ntioned . •perty on date application is filed.
Signature e!s-,� . ) Date(month,day,year)
F •-nt-:dress of appl— number ••sbeet afy,state,and ZIP code)
F 2I 3 e H. r �Nen: �9. ,cZ cxcn' /.1 y96'o
- authorized by duty executed of Attorney or by IC 6-1.1-12-0.7 / Date(month,day.year)
Address of authorized person (number and street city,state,and ZIP code) .