Loading...
HomeMy WebLinkAboutMortgage_Smith (20) e +. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year ♦ FOR DEDUCTION FROM ASSESSED VALUATION .° r �e{I pT • State Form by (RIO/11-08) Gi o N I N P SW. a Presaibed by Depanmenl of Local Government Finance I g 1•il J. INSTRUCTIONS: !� li.1e Mark To be filed in person or by mail with the County Auditor of the county where the property is located. Ol,T 4 2U�3 Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. 2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months re March 31 of each year the deduction is sought. See reverse side for additional instructions and qualifications. GIBBON COUNTY d Applicant(owner or contract buyer-see restrictions on reverse side) ( •UDITOk Rick E.and Leslie M.Smith Taxing District Key number/legal description I Reoirddmber Pa n V Patoka Township 26-11-14-100-000.926-027/Pt SE NW 14-2-11 1 Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the cup nt the sole March 1,current year March 1,current t year date of application legal or equitable owner? 5179,000.00 © Yes ❑ No If no,what Is his I 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 pjoperty in question:Annually Assessed ©Real Property ❑Annually Assessed I Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller German American Bancorp Ad ass of mortgagee or contract setter(number and street city.state,and ZIP code) I Name of assignee or other owner or er of mortgage Address of assignee(number and street city state,and ZIP code) Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property county Indiana? for current year? b in ❑ Yes ❑ No I y ❑ yes ❑ No I COUNTY AUDITOR Deduction approved in the amount of: 20 20 20 20 20 20 20 Signature of County Auditor County I 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 o• r I contract buyer ofCeeaaforementioned property on date application is filed. I S' ( 't name) /r I Date(mo1 h,day.year) . Full resident address of applicant(number and street city,state,and ZIP code) 2124 W 100 S,Princeton, IN 47670 Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day.year) Address of authorized person (number and street.pry;state,and ZIP code) I