HomeMy WebLinkAboutMortgage_Turner (2) a'" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
,;a__, . FOR DEDUCTION FROM ASSESSED VALUATION
j' State Prescribed Department(R12 me74) � � Pf
\‘‘,..1-4--,,,,� Prescribed by Department of Local Government Finance HIp
INSTRUCTIONS:
To be filed 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. ����pp "in
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properryl5"tR 9.: KY ounty Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the co
where the property is located during the twelve(12)months before March 31 of each year the deduction is .
See reverse side for additional instructions and qualifi ins. /'� GIBSON COUNT B F R
Applicant(o r contract buyer-see nctio on - �ide) 7 �L
a .Few (1.La, J
g D' trict Key number/legal descnp;i Record number Page number i ‘o
Assessed value of real roperty as of Mortgage/C6ntracl indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of a p'ca' legal or equitable owner?
/7, as
❑ 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,indicate below: Is t to property in question:Annually Assessed
pQ Real Property ❑ Annually Assessed
( � Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
e,
Address of mortgagee or contract selle CF3E-de,r)
nd street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
7— 0� 7 OP:
.d 96,e-
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 county , property for
in Indiana? Yes III No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorde,—`5-^'rhat is the basis for the deduction.
COUNTY AUDITOR 1,:1 T(11 �U. t.........t.....,,
Deduction approved in the amount of:
20 20 20 20 l CQ —
Signature of County Auditor County .D C$}\'(,+)• NO .
........ .........
1/We certify under the penalty of perjury that the above and foregoing information is true t Ca)_c1 NO and
owner/contract buyer of the aforementioned property on date application is filed. ..t t.....t......t...
Signature(o = full name) Date(month,day,year)
Full re ent address of liwnt her d scree r' state,and Zl: •i )
i. 6'30S A
Person au Dried by duly execu a Power of Attomey or by IC 6-1. -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.