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HomeMy WebLinkAboutMortgage_Seessengood (2) ;1,� . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year . y;:. FOR DEDUCTION FROM ASSESSED VALUATION State Fans 03709(R11/609) Presmbed by Department of local Government Rraince I N INSTRUCTIONS: . To be bled in person or by mail with the County Auditor or County Recorder of the county where the Form filed w'Nnc. F tc h' property is located. \ h zai5,y Ring Dates: 1) Real Property:Must file during the year for which the deduction is sought MAR C J Auditor 2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months before March 31 of each year the deduction is sought - ❑ Cou ty R rder See reverse side for additional instructions and qualifi ' ns. Apprrent rrorcyrtrdrt buyer-)e restrictions on revs see �� GIBSON COU I AUUI IOR Ta�o�-0—.) /I/ C/ n .3-Lam- WO f 7 l©g d0/es- ze,natger 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 March 1:and year March 1,arrest year date of apps legal or equitable owner? /Q 07, 066 ❑ 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 ddferent than that of applicant Indicate below: Is the property in question:Annually Assessed year Property ❑AnnuallyAssessed /X Mobile Horne(IC 6-1.1-7) - Name of mortgagee or contract seller / Address of mortgagee or contract seller(number and city,sate,and ZIP code) 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 inlndiana? rl_.._- n ..__ C.C.) _ _ _ for current year? ❑ Yes ❑ No SEC 55 a GwD) COLE COUNTY AUDITOR ►5-(01a 20 20 20 20 • County Date(month,day,year) I 1 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 data application is filed. //� Slgryture o Nil name) kJ? 1/70(41 Date(mon h,day,year) / Full /l/ N of applicant(number and v�/ te.a2 ZIP ooda . Person 7authorized by duly executed Power of Attorney or by id 6-t.1-IN2-0.7 Date(month,day,year) • Address of authorized person (number and street city sate,and ZIP code)