HomeMy WebLinkAboutMortgage_Sims " _ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
.;; FOR DEDUCTION FROM ASSESSED VALUATION-, a
I! State Fans 43709(R71/609) ...{ 1 D
Prescribed by Department of Local Government Finance
File Mark
INSTRUCI7CNS: IIIIII 99 ,,II�� Q
b be filed in person or by mail with the County Auditor or County Recorder of the county whirr'me)fropert i located. Form Acrd with:
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought. County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file durtog the pre (1men#>swe (1 s
before March 31 of each year the deduction is sought - IWl ❑ County Recorder
See reverse side for itional instructions and qua. cations. GIBSON COUNTY AUDITOR --
Applicant(owner or -'" on re rse side)
Tap istnrz A Key number/l I description Reced ryber Pay number
(9- l3-ao-aCO-CC°67/O coy Z 0(30
Assessed vdue of property of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appft ant the sole
March 1,current year March 1,cu n date of application legal or equitable owner?
5�,5— ❑ 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 drferont than that of applicant.indicate below ;1504perty in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home QC 61.1-7)
Name of mortgagee or contract seller
be
Address of mortgagee or contract seller(number and street,city,state,and 21 e)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,ciy/,1stte,end ZIP code)
Does applia Sans au (S What Taxing District? Has this deduction been requested on property _
aunty in Inc �3!/r t..1 .�0 D / I for anent year? ❑ Yes ❑ No
/q- 80 W INN AUDITOR
Deduction a;
20 . 20 20_ 20
1 I
Sign of Auditor County Date(month,day,year)
L��!X21 ,&;601- �
I 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 aforementionelipropeu7y on date application is filed.
ynasire oar're`e(141 p) Date(month,day,Year)
resident. of/a�p/Moen umber andsbae aly,slat; and ZIP..,-)
.-• a A _ A 1 .1.4 .1_ 4* --1: r
Person au. • by duty exeax -• '• - of Attorney or by IC 6-1-1-12-0-7 Date(month.da year)
Address of authorized person (number and.street aty,slate,and ZIP code) _