HomeMy WebLinkAboutMortgage_Roberts "' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co. To •(j,n jj
/� FOR DEDUCTION FROM ASSESSED VALUATION
S !• State Form
by Departrne/11-08)
t1off LLocal Government Finance Illi �
INSTRUCTIONS: F - .11 I
To be filed in person or by mail with the County Auditor of the county where the properly is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. �y
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months ach year
the deduction is sought.
GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Daniel E. Roberts and Brooke Schulze
Taxing District Key number l legal description RE�14.puln . PaS�
Ft.Branch Township 26-19-18-304-000.617-026 ((^���jll''//''// r,/997
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 March 1,current year date of application legal or equitable owner?
107000.00 98000.00 121 Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
II name on record is different than that of applicant,indicate below Is the property in question:Annually Assessed
p Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Crane Federal Credit Union
Address of mortgagee or contract seller(number and street,city state,and ZIP code)
1 West Gate Drive,Odon, IN 47562
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? for current year?
❑ Yes ❑ No ❑ 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.
gnature(owner's 1W name) E ' Date(month,day,year)
Full resident address of applicant number and street.city,state,and ZIP code)
801 E.Walnut St,Ft. Branch,IN 47648
Person authorized by duly 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 ZIP code)