HomeMy WebLinkAboutMortgage_Cox (2) }'. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS county Township Year
"I '-- FOR DEDUCTION FROM ASSESSED VALUATION
.'•'.-?s_ II State Prescribed 3709 Department r";;'s Prescribed by Department of Local Government Finance
INSTRUCTIONS: F L
To be fled in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. 2A ��b
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is EP LJ Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Reoorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the count
where the property is located during the twelve(12)months before March 31 of each year the deduction is so
See rev a s' a for additional instructions an ualifications. GIBBON COUNTY AUDITOR
App (
ero'c on� r-se js reverse side) C/ o�/4z � /
Tt' � Key num gal saiption Record
i) c 4/ - 0 —/3- leo- / / C71- V / �$ e597Y
Assessed value of real as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,Current year date of application legal or equitable owner?
❑ 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 different than that of applicant.' dicate below `IsJthe property in question:Annually Assessed
�I Real Property El As
Annually Assessed
A " — / \ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller '
Address of mortgagee or contract seller(nu. • d street,city,state,and ZIP code)
Name of assignee or other owner or holder ogage
Address of assignee(number and street,city,state,and ZIP code)
4 `fiZ- /0-/-// 792
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other on property for
in Indiana? Yes Li No current year? ❑Yes ❑No
A person is not C"-4'^thic_deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office "-- - ~odd that is recorded in the county recorder's office)that is the basis for the deduction.
4UDITOR .
Deduction appror �/�/
20 - D1'a 11'ty NO. C/"'4/ _ 20 20 20
5.
Signature of Co County Date(month,day,year)
Card NO. ...............
I/We certify under the penalty of perjury that the above and toreyun,y.,.._rmation 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.
1Y)/ S1rd1Ii*1'fl41WJ Date nth,d y year)
1� ��rY7I I
F ad bay t(numbgrand t,ci state,and IP code
Person authorized by duly execute bower of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.