HomeMy WebLinkAboutMortgage_Busing ��a_ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION yg EJ.
• ;! State Farm 43709(RU/6-09) _e ['�
Prescribed by Department of Lod Government Finance l( Li/ I)
File Mark
INSTRUCTIONS: J*1 a .t rt„ F��with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the prOperty/IS fed.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. gr County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during ff a twelve 12 fhs�
before March 31 of each year the deduction is sought - County Recorder
•See reverse side for additional instructions and qualification.. �/y1 �� GIBSON COUNTY AUDITOR
Applicant(owner a� buyer, I rcsmc , m(rQv a s)da)vV 1 r W /1
•
f ... ristrict ` - /,.. description Retard number Page number
. A � .. A ►; ; . - t4- 30\=Do -0.33 ` I oI3 3707
Assessed value of real property as of Mortgage Contact indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
Mardi 1,anent year March 1,anent year II date of application I legal or equitable owner?
17 a I'-F II I. -I-7 ❑ 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 Property ❑Annually Assessed
• I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 3
Address of mortgagee or contract seller(number and street,city.sra ,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state.and ZIP code)
_-____--____________ _ Nom • What Taring District? Has this deduction been requested on property
X13 fare
rtI yeah ❑ Yes ❑ No
Drawer NO ......••••
COUNTY AUDITOR
- Card NO. .....................
20 20 i 20_ 20
Syre -.Cormty'AUditor 1 - County ; Date(month,day,year)
I 1 We certify under the penalty oofffperjury that the above and foregoing information is true and correct and that the:applicant is a resident of Indiana and
owner 1 contract buyer of the aforementioned property on date application is filed. j
Signabrre ?s'lut cram ) e • I Date(month,day,year)
F,W resident address�appli ant(number and sfrab3aTy,state,and ZIP code) 1 1
�y a • E - •.. .t. ,Ia I I 4
Person authorized by duty executed Power of•.r. or by IC 6-1.1-12-0.7 I Date(month,day,year)
I
Address of authorized person (number and street city,state,and ZIP code) I