HomeMy WebLinkAboutMortgage_Kinsall STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE SS itLir�� .— ownship Year
r. " ,; FOR DEDUCTION FROM ASSESSED VALUATION
SaeFont�7�(R„/�) IUN 9 ZUT
' Prescribed by Department of Local Government Finance
Fill ark
INSTRUCTIONS:
fled with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property R
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought GIBSON COUNTY AUy m� aunty Auditor
2)Mobile/Manufactured Homes not aesnsed as Real Property Must file during the twelve(12)months YJ
before March 31 of each year the deduction is sought - ❑ County Recorder
See reverse side for additional instructions and qualifications.
Appacant(owner buyer-see resMClio�ns yerssa side)
r
as Key number/legal description Record number Page rum
our a /n 07- /7-/o / occ -7F5 Ca 8' dOiy /7Ki
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applont the sole
Mardi 1,current year March 1,current year date of ape/leaden legal or equitad owner?
e owne
7a ({('O ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with when,
If name on record is different than that of applicant.indicate below ,Ira the property in question:Annually Assessed
me(IC 6-1.1-7)
Name of mortgagee or contract seller 1/41 Kota. ,r & i • `
Address of mortgagee or Detract saner(number and street,city,state,and ZIP code) /''^{?M,/x•/-r F{ J
Name of assignee or other owner or holder of mortgage 17. , ,/$ (7 . o b
Address of assignee(number and street,city,state,and ZIP code) ()L J
Does applicant own property in any other If yes,what county? ��� 1n property
county in Indiana? 1:1 Yes ❑ No 'r ` O W I ❑ No •
COUNT g/3 6 ,
-
DedllcGan approved in the amount of //[_ jV�/ ���CCCJJJ
20 20 20 20 20
Signature of County Auditor •
County Data(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 I contract buyer of the aforementioned property on date application is filed.
.I re(•r •rt full name) Date(month,day,year)
Full —'•• t address of applicant(number arN s 4 crry,slate,aM ZIP code)
V l Dot. S Iw)aS hie 1-an 5t , f rine21-On , I N LF1(T1D
author-bred-bred by duly executed Power of 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) .