HomeMy WebLinkAboutMortgage_Martin (9) b�:a._4:` STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION g� g
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♦1`—S:'''9 Presaibed by Department of Local Government Finance ED
File Mark
INSTRUCTIONS: �PR r r7 r
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is local
Fling Dates: 1) Real Property Must file during the year for which the deduction is sought. I Coon Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Re during the twelve(12)month• 4..
before March 31 of each year the deduction is sought - `q'n!/D,County Recorder
See reverse side for additional instructions and qualifications. G I B S O N CO. • • • • • a'
Applicant(owner or buyer-see restriRs on,rev�rse side) p P�g�14 Taxing District b i�dl.. ' 1Y�\`awip'Wr� ,1.c . /-0 oV • I—oa U tiern`d ,ye` ICJ Y D
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,ou t year date of application legal owner?
equitable owne
,5( 0.5p ❑ Yes ❑ No
It o,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 Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller e(�A• N,l
Address of mortgagee or contract seller(number and street,city,state, P code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,rdy,state,and ZIP code)
Does applicant own property in any other If yes,what county? • What Taring District? Has this deduction been requested on property
county in Indiana? for current year?
❑ No
❑ yes ❑ Yes ❑ No
COUNTY AUDITOR
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 perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Siggabrre e n )^ Date(mona day,year)re.
Full t da ( Sand street te,and ZIP j
X O Spp nkrcn. � � .�.416_2 o
Person authorized by duly executed Power of Attorney orlay IC 6-1.1-12-0.7 Date(month,day,year)
Address of authored person (number and street,city,state.and ZIP code)