HomeMy WebLinkAboutMortgage_Young (10) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a FOR DEDUCTION FROM ASSESSED VALUATION
:i • 11c- State Forth /
Prescribed by De partm ent of Local Government Finance
ED
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the m Form fled wcdr
Pa Y ry h tv property is located. a d�with:
To alp 1
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought MA 6❑2`Cdunty Audi r
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 - ❑ -•• •er
See fever.•ar/e for additional instru. • and qualifications. 1 as ./IRTIr
c min 9�y '=seer! • mrevel;side) GIBBON COU` IY HuDiTOR
J�Qtp�tl
Record number Page number
i7-177491a. ' /7'3-300- 0635 ,C99-00z 40/3 �37C
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the approant the sole
March 1,anent year March 1,current year date of appficotion M� legal or equitable owner?
�3 � ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant.Picate below. Is property in question:Annually Assessed
ell Property ❑ArmuallyAssessed
yy��ff Mobile Hone(IC 61.1-7)
Name of mortgagee or contract seller l A'p�r/�J° / �
Address of mortgagee or contract seller(number and s ieyt toy state,,and ZIP code)
Name of assignee or other owner or holder of mortgage//JJ//
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 in Indiana? cur
❑ Yes ❑ No for rent year?
❑ Yes ❑ No •
COUNTY AUDITOR .
Deduction approved In the amount of:
20 20 20 20 20 20 20
Signature of County Auditor • I - ,(---.1---7_1
/ 1.^-'-•--,t,day,year)
Drawer NO...a0l3
1/We certify under the penally of perjury that the above and foregr a resident of Indiana and
- I contract buyer of the aforementioned property on date app .
=(owners full name) ; Card NO. a �,,r.y�, t 11,day,Year)
at, —ttifte-tat
�( Fun - ...ent of as t(n •,r. • t.01%sba .ZIP code/` X rT 6cc S. e iy, .) r
Person authorized by duly executed PoweJ of Attorney or by IC 6-1.1-12-0.7 It day,year)
Address of authorized person (number and street,city,state,and ZIP code)