HomeMy WebLinkAboutMortgage_Poskin e STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE C° ey( Township Year
FOR DEDUCTION)FROM FROM ASSESSED VALUATION q5—{
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Prescribed by Department of Loral Government Finance
File Mark
INSTRUCTIONS: r`_=; 2 0 2014
Form Ned with:
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 Properly: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 twe
before March 31 of each year the deduction is sought n County Recorder
for See reverse side hadditional instructions and qualifications.
GIBBON COUNTY AI,DIT9R
T Olstict Key number/legal description Record number Page number
o� d6-/O - 3 , -/o / -ono . 2 / 3-o a/ . 0, --b diet /
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,=Tent year March 1,current year data of appr�ton legal or equitable owner?
iep y 79 y ❑ Yes ❑ No
If ro,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
Mobile Hone(IC 61.1-7)
Name of mortgagee or contract seller
Address of mortgagee or a seller(number and street,city,state,and ZIP code) —
Name of assignee or other owner or holder of mortgage
Drawer NO 013
Address of assignee(number and street,coy,state,and ZIP code) _
Does applicant own property in any other If yes,what county? • wt. Card NO. „Len( property
county in Indiana?
❑ Yes ❑ No ❑ No
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20_ 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I I We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner/contrail buyer of the aforementioned property on date application is filed.
Signature(owner's flu nart� 1 Date(month,day year)
Y Polar,i eeruwy act/ -76/y
Full resident address of applicant(number and street city;stare,and LP code)
X 6 66C It) y00 f , OweruL,;l If TA) 4/2&'5--9/33
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day:year)
Address of authorized person (number and street city,sate.and ZIP code) _