HomeMy WebLinkAboutMortgage_Terwiske STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Y FOR DEDUCTION FROM ASSESSED VALUATION
Pretoibed y Depaim/6W) �'
Prescribed by f7ePartmeM of Loral Government Finance
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INSTRUCTIONS: I�//,,ff,,I� 55�yued
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is/otttLY/.2- 3 C U rl :
Fling Dates: 1) Real Property Must file during the year for which the deduction is sought ❑ County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)rrpgtbs. my Recorder
before March 31 of each year the deduction is sought - ,/Ji/[1 u
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUIIITOR
Applicant(owner or contract b r-see repoon reverse side)
T.:r•Distrct
/
Key raa fiber/legal dessiptrm Record number Page number
• 4l- / 3 -11 _ (00 - 000. 95 a -00 ;, i ?Dt' I a-8 2--
Assessed value of real property as of Mortgage/Contras indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current date of apPrItal on legal a equitable owner?
V DO /� I ❑ Yes ❑ No —.
If no,what is his/her exact share of interest? `�I If owned with someone other than spouse,indicate with whom
If name on rectal is different than that of appOpnt indicate below. ' �/8 IT y(/1J� ) 00
Name of mortgagee or contract seller Drawer r a�Y C r NO...•./• I!
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Address of mortgagee or contract seller(num and street ray,state,and ZIP code) -
Card NO.•
Name of assignee or other owner or holder of mortgage
Address pt assignee(number and street cal:state,and ZIP code)
11-r a sot) Nov ( I - a - 9 ci. s0 4C
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
aunty in Indiana? ❑ No for current year?
❑ Yes ❑ Yes ❑ No
i
COUNTY AUDITOR
Deduction approved in the amount at
20_ 20 20 20 20 20 20
County Date(month,day year)d Ca-/ dL mry tQr i , ur ,
I/We certify under the penalty oofpperjury that the above
and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
s^Signature(o MI rranm) /� Date(month,day,year)
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-.a/a_- LI/ `;/:2
end address of applicant(number street Sy,state,and ZIRmtle)
O0 Al 956 a 2 2ifl1 C%c�i aft #7Gfr0
Person authorized by duty executed Power of Attorney or by IC 61.1- 7/ I Data(month,day,year)
Address of authorized person (number and street dry,state,and ZIP 000de) .