HomeMy WebLinkAboutMortgage_Cook tiro?. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS county Township Year
FOR DEDUCTION FROM ASSESSED VALUATION IF I D
._ir- State Fans 43709(R11/6-09)
Prescribed by Departrnent of Local Government Fina
nce ce
1 File Mark
INSTRUCTIONS: R 2 14 Form Aed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where Ail prop1 erly i located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought 4 County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during th twelve 2 III
before March 31 of each year the deduction is sought - ❑ County Recorder
See reverse ".e for additional instructions and qualifications, GIBSON COUNTY AUDITOR
Applicant(• orz see • on re side)
QAOL
ti e ' ' /o • �y - esce o00-00D- i8 4-0 19 1 Po = i
Assessed M 0 -arrest property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appEcant the sole
yrar March 1,cun'g,pr{� coo
data of application legal or equitade owner?
V ❑ Yes ❑ No
If no,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 Properly ❑Annually Assessed
Mobile Nome(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and ' ,state, ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other If yes,what county? .- What Taxing District? Has this deduction been requested on property
county in Indiana? I ' mfor current year?
❑ No
❑ yes ❑ yes ❑ No
IUNTy AUDITOR
Deduction el -=pra"'cc �°...///
20_ �S "'•• 1 20 20 20
Cara `O• '
Sg Wre f ••••• county Date(month,trill l
I/We certfi - , trial the above and foregoing information is true and correct and that the applicant is a (ressiidenttoof Indiana and
owner I cunt •_ ..,the aforementioned property on date application is filed.
SlggaluPme) ^O /I _ ..Date(month,day,year)
—,
CIF}/ull resident address of applicant(number and street,city,state,and ZIP code)
/o Z /v, -.11-10 01 AN!}
Person authorized by duty 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,stare,and ZIP code) .