HomeMy WebLinkAboutMortgage_Sickbert STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Township Year
::: FOR DEDUCTION FROM ASSESSED VALUATION ry FILE
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State Forth by De (rtm/t-09) e`
Prescribed by Department of Lod Government Finance J!
File Mark
INSTRUCTIONS:
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 1 0 Cou Au; •r
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 Ii1 rl!!t:f Recorder
See reverse side for additional instructions and qualifications. GIBSON - a• - - -
R - 2o - U 3 - 1 o ;, - .0o 1. 9 a 7 'CO /I a o 1 .o/ J c7
Assessed nape of real property as of =re m/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1.cortent year �.�1 data of aPPttcadon legal or equitable awne?
I U �y o o i) ❑ Yes ❑ No
If 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
❑Real Properly ❑Annually Assessed
• I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller j
Address of mortgagee or contrail setter(number street-city.state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Mil of assignee(number and street,city,state.and ZIP code)
�T N1 /•JF 3 - 3 - 9 I . 4 too C
Does applicant own property in any other If yes,what county? • What Tarino District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for current yeas ❑ Yes
I ❑ No
COUNTY AUDITOR D)-a wet- J\r )x4<3
Deduction approved in the amount at C�20 20 20 20 Card No. ..1.(/ / /.....• k/
Signature d Canty Auditor County '
I
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the awn-aim.. --__.. a and
owner I co ct uyer of the aforementioned property on date application is filed.
7 m I Date(month,day,year)
I
utt intent address of applicant(number and street,dry,state,and ZIP code)
ini g - NSD �, tt (% <'i ��,n ('t, v /�C1 H76�a
authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 r I Date(north,day,year)
i
Address of authorized person (number and sheet,dry,state,and ZIP code)