HomeMy WebLinkAboutMortgage_Peyton • tar ,,ilr-
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�a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
li FOR DEDUCTION FROM ASSESSED VALUATION T I
•"'t-+a. J state Form by 43799(R11
Deartm/Fi09) $
�-J•�A Presented by DeP�nrern of Local Government Finance l -wdf 1)j
File Mark
INSTRUCTIONS: FF 7� �9 ����
To be filed in person or by mail with the County Auditor or County Recorder of the county where Yre�prtpdrlyafl&tea Foam with:
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought County Court Auditor
2) be Mobile March Manufactured 1 of a each year the educsen i as Real Property Must file during-pe hyeNe( County Recorder
before March 31 of each year the dedudiort is sought
See reverse side for additionl instructions andqualifications.
GIBSON CoUNTYgUj?tTI R
t or contract buyer-see time reverse side)
Tari p�tr�y— Key number/legal description i Record number Page number
C �., lam, a 4,-/3-/ 9-A90 c� a/0 00 1 6
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I indebtedness'unpaid as of Is the applicant the
March 1,aarerrt year Mardr 1 co t ye�ac, date of aPPfiratnn equitable legal or equita owner?
,-J v�G I ❑ Yes ❑ No
If rw,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
❑Real Property ❑Annually Assessed
• I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller J
Address of mortgagee or contract seller(number and street,city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage _
Address of assignee(number and street.city state,and: LL7C �P�
Does applicant own property in any other h D)',1)Y C 1' NO a013 s this deduction been requested on property
county in Indiana? current year?
El CI ❑ Yes ❑ No
b 1
Deduraon approved in the amount of: Ca Cl �.
33, all. —
Oa
20 20 20 _ 20 20 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
?Amer/contract buyer of the aforementioned property on date application is filed.
Signory e�� �ya reole) / , Date ". day,year)
Rd t of appfrant umber and L cr7y,state,and ZIP code)
authorized M drily ezecoted Power of Attorney or by IC 61.1-12-0.7 Date(rtnnfh,day,year)-.°
Address of authorized person (number and street dry.state.and ZIP code)