HomeMy WebLinkAboutMortgage_Lucas (3) STATEMENT OF MORTGAGE OR CONTRACT IND SS ou Township Year
f- 1
FOR DEDUCTION FROM ASSESSED VALUATION p
-cif,' State Farm 43709(R11/609)
Prescribed by Department of Local Government Frame
MAR 2 4 2014 File Mark
INSTRUCTIONS:
lb be filed in person or by mail with the County Auditor or County Recorder of the county where- e pmpe is I. -t:.• Farm teed with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought n •' 2 to' County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must Re duri . 't ! _,-- 4r nths
before March 31 of each year the deduction is sought GIBSO COUNT 'UDITOR ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant_frays or contract b r- . . on revs e)
/Ts%YZ222 l J2.011 C 2 41.f'.0-.n
o�apisb c Key number/legal description Record number Page number
n o T at/Q-//-i5 -/Do - anti 77 ^R d 0?—.7 470/ l/ 59.E
Assessed value of real of I Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,oanad year March 1,cement year date of application legal or equitable limey?
89 6,oa ❑ Yes ❑ No
If no,what is has/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is afferent than that of applicant indicate below- s the property in question:Annually Assessed
sal Property ❑Annually Assessed
Mobile Boole(IC 6-1.1-7)
Name of mortgagee or contract seller
Address at mortgagee or contrail setter(number and street.city,state,and ZIP code)
Name at assignee or other owner or holder of mortgage (/J�
Address of assignee(number and street coy,state,and ZIP code) Drawer NO..�.A'•. ........
Does applicant own property in any other If yes,what county? • What Taxing 0 C a r d N O. 5 93
county in Indiana?
El Yes C1 No
COUNTY AUDITOR - , —
Deduction approved in the amount at
20 20 20 20 20 20 20
Signature of County Auditor - County Date(moral,day,year)
I/We certify 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
?Amer/contract buyer of the aforementioned property on date application is filed.
Slgre (o hull name) Date(north,day,year)
"0 all „fill
ruIl en•address of...r•-: (number and street city,state,and ZIP code)
ttls- 5 325--W 9rtncotM i /a 47670
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,state,and ZIP code) _