HomeMy WebLinkAboutMortgage_Miles STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County • Township Year
!7'��� FOR DEDUCTION FROM ASSESSED VALUATION
'. t State Farm 43709(R11/0-09)
Prescribed by Department of Local Government Finance
F F Ma
INSTRUCTIONS:
Fa be filed in person or by mad with the County Auditor or County Recorder of the county whem the property is located.
Filing Dates: 1) Real Property 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 twelve(12)months
before March 31 of each year the deduction is sought - AP Recorder
See reve ' e for additional instructions and qualifications. (
Applicant nor b yr-see �,'.:.. , 4e e)� n a^
y • "�f�CII,� GIBSON COUNTY AUDITOR
Taxing 0' . •,d ben/ al description Renal 4��mw Page number
.. C- —1 t -D00-0a. 311 -oaf 11 yiSJ
Assessed value of real properly as of Mo ge/Contract indebtedness unpaid as of Mortgage/Conant indebtedness unpaid as of Is the applicant the sole
Marro 1,cement year Marts 1,crawl year date of application legal or equitable owner?
•JL o ❑ Yes ❑ No
If no,what is Ns r 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,Indiana bobs. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
•
Name of mortgagee or contract seller -
i ,
r � 'ni_ 1►)>
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Address of mortgagee or contract seller(number a •street,coy,state,and ZIP code) , I
Name of assignee or other owner or holder of mot - p�
Address of assignee(number and street,cat sta Draiyer NOss 0I /
V� . , .
Does applicant own property in any other /� Has this deduction been requested on property
manly in Indiana? ❑ Yes ❑ Card f)�1o. ....9q5 for amen?yeaR ❑ Yes ❑ No
Deduction approved in the amount of.
20 20 20 20_ 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjo t the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
• er I contract buyer of the aforemention roperty on date application is filed.
ex /�dfq- /u', • - 2 (\�/ ��{" ° II day, I y
UV 413 of t(n herard sba C oTy,state and ZIPV1 I atk.. o_.9 1. t.76 c
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,state,and LP code)