HomeMy WebLinkAboutMortgage_Teel Fa STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year I ei
F FOR DEDUCTION FROM ASSESSED VALUATION
State Farts 43709 Department/609)
Pre,rnbed by DepaNmrd of Lod Government Finance L ED
INSTRUCTIONS: .
To be filed in person or by mail with the County Auditor or County Recorder of the county when the property is locatac T 1 Co
x
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 f'-1
before March 31 of each year the deductions sought A L_dd_County Recorder
See reverse side for additional instructions and qualifications. )-"
buyer GIBSON Cr.rimrY 4IJDITOP
Applicant 1 - 1-4 Jr reshRriwa�veysr¢e) c/ '
Taxing District /legal description Record number Page number
2 (o - l r-le - /oo -ooq 38Y - Oat / av ( y yen7
Assessed of real of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the apprcant the sole
March 1: year Mardi 1,argent year date of application legal or equitable owner?
2..0 3 coo ❑ Yes 0 N
if no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with wham
If name on record's efferent than that of app6ant,Indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 61.1-7)
Name of nxxgagee or contract seller `Ada '
5
Address of mortgagee or contract seller(number and street,dry,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city state,and ZIP code)
,O1 (.0 1.1u1 /to -3 -« 60 .010 4 CL
Does appli ant own property in any other If yes,what county? • What Taxing Di strict? Has this deduction been requested as property
county in Indiana? ❑ Yes ❑ Noa�ntYcan ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 - 20 20 20 20 20_
Signal a of (/ ` 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 t contrail buyer of the aforementioned property on date application is filed. .
Y.Signature(a Date(month,day,year)
• >11 /o-Vs' /4
Full read of aspirant(number and street,cly.state,and ZIP code)
<f-US(J SOS Qtr eW-1 d!d ,Zit//r //,CC
Person authored by duy exewed Power of Attorney or blIC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sneer,city state,and ZIP code) •