HomeMy WebLinkAboutMortgage_Quinn (2) STATEMENT OF MORTGAGE OR CONTRACT 10 =p NE pountY Township Year
f to,.,: S
FOR DEDUCTION FROM ASSESSED VALUATI hf ' ;
State Farm 43709(R11/609) i
Presrnbed by Department of Lod Government Finance
DEC 10 2014 File Mark
INSTRUCTIONS: .
To be filed in person or by mail with the County Auditor or County Recorder of the county* ere the pmpe ( is I. •fed.
Form filed��
Prang Dates: 1) Real Property Must file during the year for which the deduction is so •Y/ _.4mm.r' -� County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must fib .i1� • .0• . L• 12)months
before March 31 of each year the deduction is sought GIBSON C•UNTY AUDITOR ❑ County Recorder
See reverse side for additional instructions and qualifications.
t contract -see restrictions on reverse side
Apps sz u�r� T side) �zas-u t
Disti id Key number/legal description Record number Page number
evil a 4,-i02 -07 -r?03-CO R. (/ '9`f oa8 /4' (5/7171
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
Mardi 1:end year March 1,anent year date of application legal or equitable owner?
79. oo El Yes El 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 different than that of app*rant,indicate below. Ak-the property in question:Annually Assessed
t2Ceal Property ❑Annually Assessed
// Mobile Horne(IC 6-1.1-7)
Name of mortgagee act seller ‘2).",
Address of mortgagee or contract seller(number and street.colt:state,and ZIP code)
V.Name of assignee or other owner or holder of mortgage (P� � Ale A� _
Address of assignee(number and sheet,city,stale,and ZIP code) �7
Does applicant own property in any other If yes,what county? • 1 /�_�/ Property
county in Indiana?
❑ Yes ❑ No ❑ 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 I contract buyer of the aforementioned property on date application is filed. .
w (owners full rams) Date(month,day,year)
a �be. 7 12 -io —/ 41
Full resident address of applicant(number and srreel,a?)f state,and ZIP code)
( 127 N (i con rF rhnce /'on Tit/ 5/71 7o . .
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(north,day,yea)
Address of authorized person (number and sheet dry,state,and ZIP code)