HomeMy WebLinkAboutMortgage_Will (5) cur.
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-ter- FOR DEDUCTION FROM ASSESSED VALUATION
4�iR^-:y�A Prescribed q'Departmem of Loral Govemmem Frence
k
INSTRUCTIONS: • nCr
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is Ikf&ad.2 7 _tl I.S Ned with:
Dates: 1) Real Property Must file during the year for which the deduction is sought _ 't] County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Me during the twelve(12)rrrypppppnths
/l _1p}�—co
before March 31 of each year the deduction is sought unty Recorder r4YPG'r`'��H�(+
See reverse side foradditionalinstructfrjns and qualifications. GIBSON COUNTY AUDITOR
App&rant(• "or contract buyer-see testtAri/cbons�n�rev/erse We)
X/- LC/t
Naxing District Key number/legal description Record number Page number
„ a _ - /9- 31- 300 - 000. S/ y- 0o9 2%oo9 aclo
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the eppficant the sole
Math 1,°Hera year March 1,cortent date of application legal or equitable owner?
000 0 Yes 0 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 app&ant-indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
• Mobile Horse(IC 6-l.1-7)
Name of mortgagee or contract seller ,s
Address of mortgagee or contract setter(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 ZIP code) DI a�Yer 1\i � 1.
Does applicant own property in any other If yes,what county? • : ed on property
county in Indiana? ❑ Yes ❑ No Card NO.O. .‘26-.70 yes ❑ No
COUNTY
Deducton approved in the amount aft
20 20 20 20 20 20 20
x
Signs of Cumry Mditw
County Date(month,day,year)
I I We cert fyy 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.
Signature(owner's AS name l Date(month,day,year)
resident s sta/�
i ( 0 . ST�i,4rVF street, spend 6 code) 1 Sii 1717639
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
•
Address of autrorisd person (number and street.ay,state,and ZIP code) _