HomeMy WebLinkAboutMortgage_Corn �, . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
ti. FOR DEDUCTION FROM ASSESSED VALUATION �� yI}�State Farm 43709(Ri t/6-09) �F Fil tl tl AA ... ... 1JLL!
Prescribed by Department of Local Government Finance
INSTRUCTIONS:
Form Ned 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: 1) Real Property Must file during the year for which the deduction is sought I O C 2a,2042
nty 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
I
See reverse side for additional instructions and qualifications. 1 . VWI(
Ap I(owner or contract buyer-see on reverse side) C�f� GIBSON COUNTY AUDITOR
o)a it t t, K 4 rn
T�0' Key number/legal description Record number Page number
(rA-�'�/�/ -�^C- lib - /Y-if- 30q - oov- a J- /-007 /3 g99Y
Assessed vahre of real as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,cement year date of appri ation legal or equitable owner?
,2a 000 I El Yes 0 N
It no,what is his I her exact share of interest? I owned with someone other than spouse,Indicate with whom------Annuaily Assessed
If name on record is different than that of appifmnt indicate below: ! 'O P I , DA-2, R c
Name of mortgagee or contract seller /� •
/ 1 E NA / ' ' _
•
Address of mortgagee or intact seller(numbbrir//and street,city,state,and ZIP code) —
Name of assignee or other owner or holder of mortgage JV — 9 1 1
Address o •-.W. i,ii ee(number and street city state,anq ZIP code) /
Does applicant own property in any other If yes,what county? • What Taxing District? Has thsldeducrian been requested on property
county in Indiana? ❑ Yes ❑ No for current year? ❑ Yes ❑ No
I COUNTY AUDITOR I
Deduction approved In the amount at
20 20 20 20 20 20 20
Signature o' f Cant Auditor County Date(npntt,day,year)
I II 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.
`_ Signorn./'fo�wner's 1t4 name) Date(rush,day,year)
.Full resident dress of t(number and ysh�eet city,state,and ZIP ZIP code)
Y3b7 S'nr,t4 flaw 57. (SA-[Cta..dCII7 Jv I/74‘40
Person authorized by duly exeatted Power of Attorney or by IC 6-1.1-12-b.7 Date(month,day year)
Address of authorized person (number and sheet city,state,and ZIP code)
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