HomeMy WebLinkAboutMortgage_Connor . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ai' l` FOR DEDUCTION FROM ASSESSED VALUATION gy og
cciPrescribed by Department( of Local Government Fiance g B
INSTRUCTIONS:
g ���FFFJIIItlY.lIEEAAfffiJ
Form To be filed in person or by mail with the Court Auditor or County Recorder of the court where the ro ,/A IDp�N"T n � 7
ty ty property is located. IYI 1__I go Q I
Fling Dates: 1) Real Property Must file during the year for which the deduction is sought LI unry ditor
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 - /n/uI/�' un r
,�(
See reverse side for additional instructions and qualifications. /Jai
Applicant(owner or contract buyer-see restrictions on reverse side)
GIBSON COUNTY AUDITOR
tiV q litre t cl. Q
Tatdrtg 0 'Key number/legal description Record number Page numbe r
%�6, -lS- 3 (0 yo3- olio. 3oo - cog ao / v VI
Assessed value of real property as of 1 MMortnage I Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the appaciant the sole
March 1,current year aarrrrhh 11 arrtent year date of apprcotion legal or equitable owneR
3 ° b ❑ Yes 0 N
If no.what is his/her exact share of interest? If owned with someone other than spouse,indicate whh whom
a-
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
—I❑Real Property ❑ N
Name of mortgagee or contract setter /�
3 Drawer NO,.,r� 0/
Address of mortgagee or contract seller(n and street city,state,and ZIP code) '
Name of assignee or other owner or holder of mortgage Card NO. %./
Address of assignee(number and street,coy,state,and ZIP code) lll"'
Does applicant own property in any other If yes,what county? • What Taxing District? Has this deduction been requesreo on taupe iv
county in Indiana? ❑ Yes ❑ No for anent year? .
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signalize of County Auditor ' County Date(month,day,Year)
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 I contract buyer of the aforementioned property on date application is filed.
`/SlgnaWre ttS Date(month,day,year)
4A.
)(W ' ent addres of applicant(number and street city,state,and ZIP mod/e) �,y 1 -�]� q / , Q
/ore 5csuiV. j2e Cr /'t, / IC:U"-V 1 1-� -�i 7(
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,ate,and ZIP code)