HomeMy WebLinkAboutMortgage_Gasaway STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
b;:lAii.....i. ili FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 93709(R1116-09)
Presm'bed by Department of Local Government Finance I_ �i i :fl
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INSTRUCTIONS: - '
Form filed with:
To be filed in person or by matil with the CountyAuditor or County Recorder of the county where the property is located. np yn�u'
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought I N LJ` 1 i 9 Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
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before March 31 of each year the deduction is sought - County Recorder
See reverse side for additional instructions and qualifications. 1. —i -rl
AppGant(owner tract buyef-see restrictions onnre e) ^ A� p GIBSON COUNTY AUDITOR
Teri Key number it!/`do '.32J.�A- o�i90-oaO Record mtm Paaeas
Assessed value of real property as of /a'1/O Mortgage r Contract Indebtedness unpaid as of Mortgage/Conrad indebtedness unpaid as Is the ap OOTpfimn��' t the sole
Mardi 1,anent year March 1,anent year date of pplca legal or equitable awmll
{/ 1b ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someoniotlier than spouse,indicate with whom
If name on record is afferent than that of applicant,indicate below. Is the property in queslion:Annually Assessed
❑RS Property ❑AnnualyAssessed
/�•.�^�/�� � ��• Mobile Home(IC 6-1.1-7)
Name of rnnrtgagee otcontract.
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Address of mortgagee or contract seller(number and street,ctly,Sam,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,dry,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? El Yes ❑ No current Yeah ❑ 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,)ear)
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/,contract buyer of the aforementioned property on date application is filed.
Signature(owners hill nam.l' Date(month,day,year)
Full resident address of applicant(number a • :,4 a1):state,and ZIP code)
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Person authorized 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,dry,state,and ZIP code) .