HomeMy WebLinkAboutMortgage_Sensmeier a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�iFOR DEDUCTION FROM ASSESSED VALUATION
= sate abed by Department t of L Fig I
Pnrsaibed by Depamnerd of Local Government Fularre ��- A .J
INSTRUCTIONS:
F County To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. O
Filing Dates: 1) Real Properly Must file during the year for which the deduction is sought. Court Auditor
• 2)Mobile/Manufactured Homes not assessed as Real Properly Must file during the twelve(12)months
before March 31 of each year the deduction is sought - ti Cou R
ac k
See reverse side for additional instructions and qualifications. GIBSON ('QU NTY AUDITOR
or contract buyer- on reverse side) �(G� ,.///� f
T-:4 Key number/legal description Rend number Page number
. 'di _ de .6 ' -Jr- AL tt.. . -CO(' ro /3 brl 2
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,current year Mardi 1,current year date of aPP�ten�, legal or equitable owner?
/v) ) ❑ Yes ❑ No
lino,what s his/her exact share of interest? If owned with someone other than�par n,indicate with whom
If name on record is different than that of applicant,Indicate beige Is property in question:Annually Assessed
Real Property ❑Annually Assessed
• (� Mobile Home(IC 6-1.1-7)
Name of mMgagee or contract seller /\`4c 22
Address of mortgagee or contract seller(number/\\(r and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,coy,state,and ZIP code)
ounty? What Taxing Datdct7 Has this deduction been requested on property
for current year? ❑ Yes ❑ No
Drawer NO �/�d�5 �]
Card NO. C-- 7 '77 COUNTY AUDITOR
(( 20 20 20 20
Signature of Caa•.ty Auditor - County Date(month,day.}ear)
I 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
owner I contract buyer of the mentioned property on date application is filed.
1c Signal owners fur) Date(month,day,year)
r
Full resident address of applicant(numberard �..d1Y,�te. ZIP
e-, 4tso S, gas,,,../g_
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authorized by duty executed Power of Attorney or by IC 1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state.and ZIP code)